脓毒症、多器官功能障碍综合征治疗前后的证候要素特征*

谢东平范荣荣韩 云杜炯栋赖 芳（.广州中医药大学第二临床医学院，广东 广州 50370；.广州中医药大学第三附属医院，广东 广州 5040）

·证治探讨·

脓毒症、多器官功能障碍综合征治疗前后的证候要素特征*

谢东平1范荣荣2韩 云1杜炯栋1赖 芳1
（1.广州中医药大学第二临床医学院，广东 广州 510370；2.广州中医药大学第三附属医院，广东 广州 510240）

目的 探讨内科脓毒症、多器官功能障碍综合征（MODS）患者治疗前后的证候要素特征。方法 采用前瞻性临床观察设计，初始共纳入内科脓毒症、MODS患者143例，治疗后共98例患者好转，采集患者治疗前后的中医四诊信息及APACHEⅡ评分等现代医学指标，进行证候要素判定。结果 好转的一般脓毒症患者治疗后火热证及血瘀证明显减少（P＜0.05）；好转的严重脓毒症患者治疗后火热证及血瘀证明显减少（P＜0.05）；而好转的MODS患者治疗后痰证、阳虚证、火热证、血瘀证均明显减少（P＜0.05）。所有治疗前的纳入对象，按照主要证候要素（火热证、痰证、血瘀证、气虚证、阳虚证）的有无分为两组，比较两组间的降钙素原、C反应蛋白水平，结果显示差异均无统计学意义（P＞0.05），提示上述证候要素与降钙素原、C反应蛋白无明显相关性。结论 火热证、血瘀证是脓毒症早期的治疗重点，而当病情进展至MODS阶段时，需要兼顾阳虚证。

脓毒症 多器官功能障碍综合征 证候 证候要素

【Abstract】Objective：To investigate TCM syndrome elements characteristics of sepsis and MODS before and after treatment.Methods：In a prospective study，143 patients who were diagnosed sepsis or septic MODS were enrolled.After treatment，98 patients were improved.The information of TCM four examinations，APACHEⅡscores and other experiments results were collected，and the syndrome element type was identified before and after treatment.Results：After treatment，heat syndrome and blood stasis syndrome were reduced significantly in improved patients with sepsis，as well as the patients with severe sepsis（P＜0.05）.Phlegm syndrome，Yang deficiency syndrome，heat syndrome，and blood stasis syndrome were reduced significantly at patients with septic MODS（P ＜0.05）.According to the main syndrome elements（heat syndrome，phlegm syndrome，blood stasis syndrome，Qi deficiency syndrome，Yang deficiency syndrome），all the included objects before treatment were divided into two groups.The comparison between the two groups showed no statistical significance in procalcitonin and C-reactive protein level，which meant that there was no significant correlation between the main syndrome elements and procalcitonin and C-reactive protein.Conclusion：Heat syndrome and blood stasis syndrome should be emphasized in the early stage of sepsis.But in the stage of septic MODS，Yang deficiency syndrome should be emphasized，too.

【Key words】Sepsis；MODS；TCM syndrome；Syndrome elements

脓毒症（Sepsis）及其所导致的多器官功能障碍综合征（MODS）是发病率高、病情凶险、致死率高的一类疾病。尽管西医抗感染等治疗和器官功能支持技术取得了长足的发展，但其病死率仍居高不下，且大量抗生素的使用造成耐药菌泛滥。……