410例重症脓毒症患者中医证候的临床分析

目的 总结重症脓毒症的中医证候的临床特征.方法 将本课题组前瞻性收集的410例包含中医信息的重症脓毒症的患者临床资料进行分析,统计各项证候发生的频数.结果 重症脓毒症410病例为成人重症病例,年龄15～99岁,平均（62.9±18.8）岁,APACHEⅡ分值为2～50分,平均（23.4±9.8）分.在本组重症脓毒症患者中,脉象中最常见的是脉微弱205例（50.0％）、其次为沉细137例（33.4％）、滑31例（7.6％）和洪大37例（9.0％）.在本组重症脓毒症患者中,舌象中最常见的是舌体胖大159例（38.8％）,舌质苍白156例（38.0％）、紫暗125例（30.5％）,舌苔白177例（43.2％）、舌苔黄141例（34.4％）,舌苔厚228例（55.6％）,舌苔腻219例（53.4％）.最常见的证候有痰340（82.9％）、发热337（82.2％）、腹胀337（82.2％）、神志不清314（76.6％）、出汗251（61.2％）、肢端湿冷248（60.5％）、心悸248 （60.5％）、水肿243 （59.3％）、躯体疼痛201（49％）,其次为口干欲饮198 （48.3％）、肠道不排气223 （54.4％）、休克178 （43.4％）、皮肤瘀点瘀斑162（39.5％）、畏寒108（26.3％）.结论 本研究结果的证候结果显示符合脓毒症各期各证型的诊断要素,是诊断重症脓毒症时中医辨证的重要参考依据.

Clinical Analysis of Traditional Chinese Medicine Symptoms of 410 Severe Sepsis Cases

Objective： To summarize the clinical features of traditional Chinese medicine symptoms of severe sepsis. Methods： We prospectively collected and analyzed the clinical datas of 410 severe sepsis patients,including TCM informations,then counted the frequency of the symptoms. Results： In the 410 adult severe sepsis patients,.age range from 15 to 99 years old,mean age was （62.9±18.8） years old. APACHE Ⅱ score was from 2 to 50 points. Its average points was （23.4＋9.8）. Among them,the most common pulse was faint and weak pulse 205 cases （50.0%） ,followed by deep and thready pulse 137 cases （33.4%） ,slippery pulse 31 cases （7.6%） and surging pulse 37 cases （9.0%）. The most common tongue manifestation were plump tongue 159 cases （38.8%）, pale tongue 156 cases （38.0%）,dark purple tongue 125 cases （30.5%）,white fur 177 cases （43.2%）,yellow fur 141 cases （34.4%）,thick fur 228 cases （55.6%）,greasy fur 219 cases （53.4%）.The most common symptoms were sputum production 340 cases （82.9%）,fever 337 cases （82.2%）,abdominal distension 337 cases （82.2%）, unconsciousness 314 cases （76.6%）,sweating 251 cases （61.2%）,clammy extremities 248 cases （60.5%）,palpitations 248 cases （60.5%）,edema 243 cases （59.3%）,bodily pain 201 cases （49%）,fallowed by dry mouth with desire to drink 198 cases （48.3%）,intestinal not exhaust 223 cases （54.4%）,shock 178 （43.4%）,skin petechiae and ecchymosis 162 cases （39.5%）,chills 108 cases （26.3%）. Conclusion： The symptom results of this study are in accordance with the diagnosis element of sepsis of various type and period. They are important references to traditional Chinese medicine syndrome differentiation of severe sepsis.