本文選題：膿毒癥心肌損傷 + 證素　； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：目的探討膿毒癥心肌損傷患者中醫(yī)證素、證型分布特點及其與相關(guān)因素的關(guān)系,為臨床辨證論治提供參考。方法通過回顧性研究的方法,收集從2011年1月1日至2016年11月30日期間,在廣安門醫(yī)院重癥監(jiān)護室住院的膿毒癥心肌損傷患者的臨床資料。對納入病例進行橫斷面調(diào)查,采集相關(guān)信息,填寫病例報告表(CRF),并錄入數(shù)據(jù)庫,運用統(tǒng)計軟件SPSS 21.0進行分析,探討證素、證型分布情況以及與相關(guān)因素之間的關(guān)系。結(jié)果1.一般資料:182例患者,其中男性104例,占57%,女性78例,占43%。年齡介于45-99歲,平均年齡78.1 ±8.62歲。本研究中膿毒癥心肌損傷常見原發(fā)病包括肺部感染、泌尿系感染、腹腔感染,占比依次為80%、11%、6%。常見基礎(chǔ)病為高血壓病、冠心病、腦卒中及慢性阻塞性肺疾病,占比依次為68%、54%、41%、20%。2.常見證素及組合情況:以虛實為綱,證素組合情況及比例如下:虛實夾雜證102例,占56%;實證63例,占35%;虛證17例,占9%。實證證素以痰證、熱證及血瘀證為主,所占比例依次為25%、18%、18%。常見虛證證素及所占比例為氣虛證占11%,陰虛證占8%,陽虛證占6%。證素組合以三證素組合最多見,共106例,其次為兩證素組合,共52例。其中三證素組合及所占比例:氣虛血瘀痰證占41%,陰虛熱血瘀證占29%,陽虛痰濕證占23%;兩證素組合及其構(gòu)成比為:痰熱證占76%,熱毒證占16%。3.SIMD患者臨床常見證型例數(shù)及比例如下:氣虛血瘀痰阻證46例,占25%;痰熱阻閉證38例,占21%;陰虛熱結(jié)血瘀證32例,占18%;陽虛痰濕內(nèi)阻證26例,占14%。4.常見證型與理化指標的關(guān)系:陰虛熱結(jié)血瘀證組cTnI最高,痰熱阻閉證組最低(P0.05)。陽虛痰濕內(nèi)阻證組與痰熱阻閉證組比較pro-BNP,差異有統(tǒng)計學(xué)意義。陽虛痰濕內(nèi)阻證組的FT3及FT4最低,與其他證型組相比,有顯著差異。5.常見證型與預(yù)后的相關(guān)性:在ICU住院天數(shù)、APACHEⅡ評分、病死率方面,陽虛痰濕內(nèi)阻證組與痰熱阻閉證組相比,均有顯著差異。結(jié)論1.證素證型分布情況:膿毒癥心肌損傷(SIMD)常見實證證素為痰證、熱證與血瘀證;虛證證素以氣虛證、陰虛證與陽虛證為主;證型以氣虛血瘀痰阻證、痰熱阻閉證、陰虛熱結(jié)血瘀證與陽虛痰濕內(nèi)阻證為常見。2.常見證型與理化指標的關(guān)系:陰虛熱結(jié)血瘀證的cTnI值明顯高于其他組,提示陰虛熱結(jié)血瘀證的SIMD患者心肌損傷程度較其他證型嚴重。陽虛痰濕內(nèi)阻證的FT3及FT4明顯低于其他組,pro-BNP明顯高于其他組,提示陽虛痰濕內(nèi)阻證患者應(yīng)預(yù)防心衰的發(fā)生。3.常見證型與預(yù)后相關(guān)性:SIMD患者中陽虛痰濕內(nèi)阻證預(yù)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 鹵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，

本文編號：1888428