重症肺炎合并应激性溃疡出血的中医证候研究

赵玉清 张立平 方晓磊 宋莹莹

摘要 目的：初步探索重症肺炎合并应激性溃疡出血的中医证候及主要证型，为辨证施治提供依据。方法：选取2014年1月1日至12月31日北京中医药大学东方医院收治的重症肺炎合并应激性溃疡出血患者60例作为研究对象。对主要症状体征直接辨证，对伴随症状体征采用因子分析寻找该疾病的常见中医证候，并统计其分布特点。结果：本病涉及的主要脏腑为肺、脾，主要证候符合痰热蕴肺证特点，伴随症状体征辨证显示气阴亏虚、肺脾不足兼见痰浊、瘀血的特点。结论：重症肺炎合并应激性溃疡出血初期以痰热壅肺为基础证型、核心证型，在此基础上可见气阴两虚、肺脾不足的证候表现，同时兼见痰湿、血瘀之象，病性虚实夹杂，病位在肺脾。

关键词 重症肺炎;应激性溃疡出血;因子分析;证候;虚实夹杂;痰热蕴肺;气阴两虚;肺脾不足

Abstract Objective：To initially explore the syndrome elements and main syndrome types of severe pneumonia complicated with stress ulcer hemorrhage，and to provide evidence for syndrome differentiation and treatment.Methods：A total of 60 cases of severe pneumonia with stress ulcer hemorrhage in Dongfang Hospital，Beijing University of Chinese Medicine were selected as the research subjects.The main symptoms were directly dialectical，and the factor analysis was used to find the common syndrome elements of the disease，and the distribution characteristics of the syndrome elements were statistically analyzed.Results：The main viscera involved in this disease were lung and spleen，and the main symptoms were in line with the characteristics of phlegm-heat accumulation of lung syndrome.Conclusion：The syndrome elements in the early stage of severe pneumonia complicated with stress ulcer bleeding are based on phlegm，heat obstructed in lung as the basic and core syndrome.The syndromes of deficiency of qi and yin and deficiency of lung and spleen can be seen.At the same time，the symptoms of phlegm-dampness and blood stasis can also be observed.The disease is mixed with the deficiency and excess，the location of the disease is in the lung and spleen.

Keywords Severe pneumonia; Stress ulcer hemorrhage; Factor analysis; Syndrome elements; Inclusion of deficiency and excess; Phlegm and heat accumulate in the lungs; Deficiency of qi and yin; Insufficiency of lung and spleen

中图分类号：R241文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.17.029

随着社会老龄化的进程，重症肺炎（Severe Pneumonia，SP）的发生率及病死率逐年增加。据报道，我国重症肺炎的病死率高达53%[1]，欧美国家重症肺炎的病死率为27%～67%[2]，龙怀聪等[3]回顾性研究162例重症肺炎患者发现病死率高达79.0%。重症肺炎的发生已促使肺炎成为全球致死率排名第三的疾病。重症肺炎导致的感染、脓毒症、缺氧等使本病合并应激性溃疡（Stress Ulcer，SU）出血的发生率也呈上升趋势。应激性溃疡是指机体在各类严重创伤、危重疾病或严重心理疾病等应激状态下发生的急性胃肠道黏膜糜烂、溃疡等病变，严重者可并发消化道出血，甚至穿孔，可使原有疾病的程度加重及恶化，增加病死率。……