本文選題：膿毒癥　切入點(diǎn)：心功能障礙　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本課題采用回顧性分析的研究方法,探討膿毒癥患者的中醫(yī)證候、證素分布規(guī)律,以及膿毒癥患者誘導(dǎo)心功能障礙的危險(xiǎn)因素和預(yù)后特點(diǎn)。方法:選取2012年01月-2016年12月廣東省中醫(yī)院重癥監(jiān)護(hù)病房符合膿毒癥診斷標(biāo)準(zhǔn)的患者,共226例。記錄患者的基礎(chǔ)病史、一般資料及臨床癥狀等內(nèi)容,歸納膿毒癥患者的中醫(yī)證型和證素特點(diǎn);同時記錄患者臨床相關(guān)的預(yù)后指標(biāo),如LVEF、NT-proNP、CRP、白蛋白、降鈣素原、乳酸、APTT、SOFA評分、APACHEⅡ評分等,建立臨床數(shù)據(jù)庫,用軟件進(jìn)行統(tǒng)計(jì)分析,篩查膿毒癥患者出現(xiàn)心功能障礙的中醫(yī)證型和其它危險(xiǎn)因素,并觀察總體人群和不同中醫(yī)證型人群的病死率。結(jié)果:1.在226例膿毒癥患者中,虛實(shí)夾雜證最多,占60.6%,其次為實(shí)證,占34.1%,急性虛證占5.3%。研究人群中共記錄9種基本中醫(yī)證候要素,總頻次為663,按頻次分布出現(xiàn)最多的依次是氣虛證(21.6%)、熱證(17.0%)和痰證(16.3%)。在膿毒癥心功能障礙組主要以虛實(shí)夾雜證為主,非心功能障礙組主要以虛實(shí)夾雜證和實(shí)證為主。氣虛和血瘀證在兩組之間的分布亦存在統(tǒng)計(jì)學(xué)差異(P0.05)。2.針對誘導(dǎo)膿毒癥患者出現(xiàn)心功能障礙的相關(guān)因素,進(jìn)行單因素回歸分析發(fā)現(xiàn),入院或者轉(zhuǎn)入ICU時表現(xiàn)為實(shí)證、近期手術(shù)、冠心病史和慢性腎臟病史具有統(tǒng)計(jì)學(xué)意義(P0.05),進(jìn)一步將上述因素納入多因素邏輯回歸模型后發(fā)現(xiàn)冠心病史和慢性腎臟病史是膿毒癥患者出現(xiàn)心功能障礙的危險(xiǎn)因素。3.在28天病死率的比較上,心功能障礙組高于非心功能障礙組,差異存在統(tǒng)計(jì)學(xué)意義(P0.05);納入研究的所有研究對象三組證候間死亡率的差異存在統(tǒng)計(jì)學(xué)意義(P0.05),死亡率由高到低依次為急性虛證組、虛實(shí)夾雜證組和實(shí)證組。結(jié)論:1.膿毒癥及膿毒癥心功能障礙患者的中醫(yī)證型均以虛實(shí)夾雜者為主,并發(fā)心功能障礙的膿毒癥患者早期更多具備氣虛及血瘀等病理因素。2.冠心病史和慢性腎臟病史是膿毒癥患者出現(xiàn)心功能障礙的危險(xiǎn)因素。3.入院或轉(zhuǎn)入ICU時表現(xiàn)為實(shí)證的膿毒癥患者比急性虛癥和虛實(shí)夾雜證者具有更低的死亡風(fēng)險(xiǎn)。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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