脓毒症诱导心功能障碍的中医证型及相关因素分析

发布时间：2018-04-10 02:06

本文选题：脓毒症　切入点：心功能障碍　出处：《广州中医药大学》2017年硕士论文

【摘要】：目的:本课题采用回顾性分析的研究方法,探讨脓毒症患者的中医证候、证素分布规律,以及脓毒症患者诱导心功能障碍的危险因素和预后特点。方法:选取2012年01月-2016年12月广东省中医院重症监护病房符合脓毒症诊断标准的患者,共226例。记录患者的基础病史、一般资料及临床症状等内容,归纳脓毒症患者的中医证型和证素特点;同时记录患者临床相关的预后指标,如LVEF、NT-proNP、CRP、白蛋白、降钙素原、乳酸、APTT、SOFA评分、APACHEⅡ评分等,建立临床数据库,用软件进行统计分析,筛查脓毒症患者出现心功能障碍的中医证型和其它危险因素,并观察总体人群和不同中医证型人群的病死率。结果:1.在226例脓毒症患者中,虚实夹杂证最多,占60.6%,其次为实证,占34.1%,急性虚证占5.3%。研究人群中共记录9种基本中医证候要素,总频次为663,按频次分布出现最多的依次是气虚证(21.6%)、热证(17.0%)和痰证(16.3%)。在脓毒症心功能障碍组主要以虚实夹杂证为主,非心功能障碍组主要以虚实夹杂证和实证为主。气虚和血瘀证在两组之间的分布亦存在统计学差异(P0.05)。2.针对诱导脓毒症患者出现心功能障碍的相关因素,进行单因素回归分析发现,入院或者转入ICU时表现为实证、近期手术、冠心病史和慢性肾脏病史具有统计学意义(P0.05),进一步将上述因素纳入多因素逻辑回归模型后发现冠心病史和慢性肾脏病史是脓毒症患者出现心功能障碍的危险因素。3.在28天病死率的比较上,心功能障碍组高于非心功能障碍组,差异存在统计学意义(P0.05);纳入研究的所有研究对象三组证候间死亡率的差异存在统计学意义(P0.05),死亡率由高到低依次为急性虚证组、虚实夹杂证组和实证组。结论:1.脓毒症及脓毒症心功能障碍患者的中医证型均以虚实夹杂者为主,并发心功能障碍的脓毒症患者早期更多具备气虚及血瘀等病理因素。2.冠心病史和慢性肾脏病史是脓毒症患者出现心功能障碍的危险因素。3.入院或转入ICU时表现为实证的脓毒症患者比急性虚症和虚实夹杂证者具有更低的死亡风险。
[Abstract]:Objective: to investigate the TCM syndromes, distribution of syndromes, risk factors and prognosis of sepsis patients with cardiac dysfunction by retrospective analysis.Methods: 226 patients with sepsis in intensive care unit of Guangdong traditional Chinese Medicine Hospital from January 2012 to December 2016 were selected.The basic history, general data and clinical symptoms of the patients were recorded, and the TCM syndromes and syndromes of sepsis were summarized, and the clinical prognostic indexes, such as LVEFU NT-proNPP, albumin, procalcitonin, were also recorded.The clinical database was established and the statistical analysis was carried out with software to screen the TCM syndromes and other risk factors of cardiac dysfunction in sepsis patients, and to observe the fatality rate of the whole population and different TCM syndromes.The result is 1: 1.Among 226 patients with sepsis, the syndrome of deficiency and deficiency was the most, accounting for 60.6, followed by positivism, accounting for 34.1and acute deficiency, accounting for 5.3.The total frequency of 9 basic TCM syndromes was 663, and the most frequently distributed were Qi deficiency syndrome (21.6N), heat syndrome (17.0cm) and phlegm syndrome (16.3C).In septic heart dysfunction group, deficiency and excess inclusion syndrome was the main type, and non-cardiac function disorder group was mainly deficiency and solid inclusion syndrome and empirical evidence.There was also a statistical difference in the distribution of qi deficiency and blood stasis between the two groups.Univariate regression analysis of the factors associated with cardiac dysfunction in patients with sepsis showed that admission or transfer to ICU was positive.The history of coronary heart disease (CHD) and chronic kidney disease (CHD) were statistically significant (P 0.05). After the above factors were incorporated into the multivariate logistic regression model, it was found that the history of coronary heart disease and chronic kidney disease were risk factors of cardiac dysfunction in sepsis patients.In comparison of the fatality rate of 28 days, the cardiac dysfunction group was higher than the non-cardiac dysfunction group.The difference was statistically significant (P 0.05), and the difference of death rate among the three groups was statistically significant. The mortality rate from high to low was acute deficiency syndrome group, deficiency syndrome group and empirical group.Conclusion 1.The TCM syndromes of patients with sepsis and sepsis heart dysfunction are mainly composed of deficiency and solid. Sepsis patients with cardiac dysfunction have more pathological factors such as qi deficiency and blood stasis in the early stage. 2.History of coronary heart disease and chronic kidney disease are risk factors of heart dysfunction in sepsis patients.Sepsis patients who were admitted or transferred to ICU had a lower risk of death than those with acute deficiency and deficiency syndrome.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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