脓毒症心肌损伤的证素证型分布规律及其相关因素的临床研究

发布时间：2018-05-14 15:18

  本文选题：脓毒症心肌损伤 + 证素　； 参考：《中国中医科学院》2017年硕士论文

【摘要】：目的探讨脓毒症心肌损伤患者中医证素、证型分布特点及其与相关因素的关系,为临床辨证论治提供参考。方法通过回顾性研究的方法,收集从2011年1月1日至2016年11月30日期间,在广安门医院重症监护室住院的脓毒症心肌损伤患者的临床资料。对纳入病例进行横断面调查,采集相关信息,填写病例报告表(CRF),并录入数据库,运用统计软件SPSS 21.0进行分析,探讨证素、证型分布情况以及与相关因素之间的关系。结果1.一般资料:182例患者,其中男性104例,占57%,女性78例,占43%。年龄介于45-99岁,平均年龄78.1 ±8.62岁。本研究中脓毒症心肌损伤常见原发病包括肺部感染、泌尿系感染、腹腔感染,占比依次为80%、11%、6%。常见基础病为高血压病、冠心病、脑卒中及慢性阻塞性肺疾病,占比依次为68%、54%、41%、20%。2.常见证素及组合情况:以虚实为纲,证素组合情况及比例如下:虚实夹杂证102例,占56%;实证63例,占35%;虚证17例,占9%。实证证素以痰证、热证及血瘀证为主,所占比例依次为25%、18%、18%。常见虚证证素及所占比例为气虚证占11%,阴虚证占8%,阳虚证占6%。证素组合以三证素组合最多见,共106例,其次为两证素组合,共52例。其中三证素组合及所占比例:气虚血瘀痰证占41%,阴虚热血瘀证占29%,阳虚痰湿证占23%;两证素组合及其构成比为:痰热证占76%,热毒证占16%。3.SIMD患者临床常见证型例数及比例如下:气虚血瘀痰阻证46例,占25%;痰热阻闭证38例,占21%;阴虚热结血瘀证32例,占18%;阳虚痰湿内阻证26例,占14%。4.常见证型与理化指标的关系:阴虚热结血瘀证组cTnI最高,痰热阻闭证组最低(P0.05)。阳虚痰湿内阻证组与痰热阻闭证组比较pro-BNP,差异有统计学意义。阳虚痰湿内阻证组的FT3及FT4最低,与其他证型组相比,有显著差异。5.常见证型与预后的相关性:在ICU住院天数、APACHEⅡ评分、病死率方面,阳虚痰湿内阻证组与痰热阻闭证组相比,均有显著差异。结论1.证素证型分布情况:脓毒症心肌损伤(SIMD)常见实证证素为痰证、热证与血瘀证;虚证证素以气虚证、阴虚证与阳虚证为主;证型以气虚血瘀痰阻证、痰热阻闭证、阴虚热结血瘀证与阳虚痰湿内阻证为常见。2.常见证型与理化指标的关系:阴虚热结血瘀证的cTnI值明显高于其他组,提示阴虚热结血瘀证的SIMD患者心肌损伤程度较其他证型严重。阳虚痰湿内阻证的FT3及FT4明显低于其他组,pro-BNP明显高于其他组,提示阳虚痰湿内阻证患者应预防心衰的发生。3.常见证型与预后相关性:SIMD患者中阳虚痰湿内阻证预后不良。
[Abstract]:Objective to explore the distribution of TCM syndromes, syndromes and related factors in patients with septic myocardial injury and to provide reference for clinical treatment based on syndrome differentiation. Methods from January 1, 2011 to November 30, 2016, the clinical data of patients with septic myocardial injury in intensive care unit of Guanganmen Hospital were collected by retrospective study. Cross-sectional investigation was carried out, relevant information was collected, the case report form was filled in and the data was entered into the database. The statistical software SPSS 21.0 was used to analyze the factors of syndrome, the distribution of syndromes and the relationship between them and related factors. Result 1. General data: 182 patients, 104 males (57%), 78 females (43 cases). The average age was 78.1 卤8.62 years old. In this study, the common primary diseases of sepsis myocardial injury include pulmonary infection, urinary tract infection and abdominal infection, accounting for 80% in turn. The common underlying diseases were hypertension, coronary heart disease, stroke and chronic obstructive pulmonary disease, which accounted for 6854% in turn. The common syndromes and their combinations are as follows: 102 cases (56 cases) with deficiency and solid mixed syndrome, 63 cases (35 cases) with empirical evidence, and 17 cases (9%) with deficiency syndrome. Phlegm syndrome, heat syndrome and blood stasis syndrome are the main syndromes, and the proportion of them is 25% and 18% respectively. The common deficiency syndrome element and its proportion are Qi deficiency syndrome, Yin deficiency syndrome and Yang deficiency syndrome, respectively. The combination of three syndromes was the most common in 106 cases, followed by the combination of two syndromes (52 cases). The combination of three syndromes and their proportion: Qi deficiency, blood stasis and phlegm syndrome, Yin deficiency, heat and blood stasis syndrome, yin deficiency, heat and blood stasis syndrome, and yang deficiency and phlegm dampness syndrome, respectively, and their composition ratio are as follows: phlegm heat syndrome accounts for 76g, heat toxin syndrome accounts for the number and ratio of clinical common syndromes of 16%.3.SIMD patients. Examples are as follows: Qi deficiency, blood stasis, phlegm obstruction, 46 cases, Accounts for 25 cases; phlegm heat obstruction syndrome 38 cases (21 cases); Yin deficiency heat knot blood stasis syndrome 32 cases (18 cases); Yang deficiency phlegm dampness internal obstruction syndrome 26 cases (14. 4%). The relationship between common syndromes and physical and chemical indexes: the cTnI was the highest in the group of Yin deficiency and heat and blood stasis, and the lowest in the group of blocking phlegm and heat (P 0.05). There was significant difference in pro-BNPs between Yang deficiency and phlegm dampness blocking syndrome group and phlegm heat blocking syndrome group. The FT3 and FT4 of Yang deficiency phlegm dampness obstruction syndrome group were the lowest, and there was significant difference between the two groups. Correlation between common syndromes and prognosis: there were significant differences in Apache 鈪，

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