重症肺炎患者中医证型与氧合指数、乳酸、D-二聚体的关系研究

目的探讨重症肺炎中医证型分布特点及其与氧合指数p_a(O₂)/F_iO₂]、乳酸(Lac)、D-二聚体(D-D)的关系。方法选取118例重症肺炎患者为研究对象,观察主要中医证型分布特点。观察患者急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,检查血常规,并检测C反应蛋白(CRP)、p_a(O₂)/F_iO₂、Lac、D-D、血清总胆红素(TBil)、血清肌酐(Cr)水平。结果118例重症肺炎患者中,痰热壅肺证68例(57.63%),痰湿阻肺证25例(21.19%),热闭心包证14例(11.86%),邪陷正脱证11例(9.32%)。邪陷正脱证、热闭心包证患者APACHEⅡ评分、白细胞计数(WBC)、CRP、D-D、TBil水平均高于痰热壅肺证及痰湿阻肺证患者,而p_a(O₂)/F_iO₂水平低于痰热壅肺证及痰湿阻肺证患者,差异有统计学意义(P<0.05);邪陷正脱证患者Lac及Cr水平均高于其他证型患者,差异有统计学意义(P<0.05);痰热壅肺证患者WBC及CRP水平均高于痰湿阻肺证患者,差异有统计学意义(P<0.05);邪陷正脱证患者D-D水平高于热闭心包证患者,差异有统计学意义(P<0.05)。结论重症肺炎患者入院时中医证型主要为痰热壅肺证、痰湿阻肺证、热闭心包证和邪陷正脱证,其中痰热壅肺证最常见。检测p_a(O₂)/F_iO₂、Lac、D-D水平对中医辨证分型有一定参考价值。

Study on relationships between traditional Chinese medicine syndromes and oxygenation index,lactic acid,D-dimer in patients with severe pneumonia

Objective To study relationships between traditional Chinese medicine(TCM)syndromes and oxygenation indexp_a(O₂)/F_iO₂],lactic acid(Lac),D-dimer(D-D)in patients with severe pneumonia.Methods A total of 118 patients with severe pneumonia were selected as study objects,and their distribution characteristics of TCM syndromes were observed.APACHEⅡscores,blood routine examination,levels of C-reactive protein(CRP),p_a(O₂)/F_iO₂,Lac,D-D,serum total bilirubin(TBil)and serum creatinine(Cr)were measured.Results Out of 118 patients with severe pneumonia,there were 68 cases(57.63%)with phlegm-heat accumulating in lungs syndrome,25 cases(21.19%)with phlegm-dampness obstructing lungs syndrome,14 cases(11.86%)with heat closure pericardium syndrome,and 11 cases(9.32%)with interior invasion of pathogen and vital qi collapse syndrome.The APACHEⅡscores,the levels of white blood cell count(WBC),CRP,D-D and TBil in the patients with interior invasion of pathogen and vital qi collapse syndrome and heat closure pericardium syndrome were significantly higher,and the levels of p_a(O₂)/F_iO₂ were significantly lower than those with phlegm-dampness obstructing lungs syndrome and phlegm-heat accumulating in lungs syndrome(P<0.05).The levels of Lac and Cr in patients with interior invasion of pathogen and vital qi collapse syndrome were higher than those with other syndromes(P<0.05).The levels of WBC and CRP in patients with phlegm-heat accumulating in lungs syndrome were significantly higher than those with phlegm-dampness obstructing lungs syndrome(P<0.05);the levels of D-D in patients with interior invasion of pathogen and vital qi collapse syndrome were significantly higher than those with heat closure pericardium syndrome(P<0.05).Conclusion At admission,TCM syndromes of patients with severe pneumonia mainly include phlegm-heataccumulating in lungs,phlegm-dampness obstructing the lungs,heat closure pericardium,and interior invasion of pathogen and vital qi collapse,and the most commonly occurring syndrome is phlegm-heat accumulating in lungs.The detection of p_a(O₂)/F_iO₂,Lac and D-D levels has certain reference value for TCM syndrome differentiation.