摘要
目的总结真菌性脓毒症患者的中医证候学特征,通过数据挖掘分析中药组方规律并评估临床疗效,为中医药治疗真菌性脓毒症提供依据。方法回顾性收集首都医科大学附属北京中医医院重症医学科2007年7月1日至2022年7月31日入院的脓毒症患者的临床资料,病原学检验显示真菌感染。采集患者一般情况、中医四诊信息、辨证分型、中药使用情况,采用频数、频率进行描述性统计。中药方面采用R语言进行中药频数统计、高频中药关联分析,通过SPSS进行聚类分析。分析患有不同基础疾病的真菌性脓毒症患者的中药应用情况。临床疗效通过好转率和APACHEⅡ评分进行评估。结果本研究共纳入患者95名,主要为白念珠菌感染患者,男性51例,女性44例,年龄(84.9±11.2)岁。感染部位方面以肺部真菌感染为主。预后方面,真菌性脓毒症患者28 d病死率为11.6%。患者伴有多种基础疾病,临床以发热、咳嗽、喘憋、意识障碍为主要症状,舌象以舌红或舌淡白、苔白腻多见,脉象以细、弦、滑、沉为主。证候方面,痰热壅肺证、气阴两虚证为主要的临床证候。中药的应用以苦寒、甘温药为主,主要归肺经、脾经、胃经,发挥补益虚损、清热解毒、利湿化痰、活血祛瘀等作用。关联规则分析得出核心药物组合为黄芪-当归-金银花-甘草,蛇床子-苦参-干姜,红花-白术-陈皮,枳壳-陈皮-柴胡等。聚类分析将高频中药分为2个有效类方群,分别侧重祛除病邪和补益虚损。基础疾病对患者的用药亦有影响,根据基础疾病的不同,在治疗上有侧重地施以通利心脉、清肺平喘、疏肝解毒、补益肾阳、健脾燥湿之法。临床好转率为86.3%,出院时APACHEⅡ评分较入院时明显降低(P<0.05)。结论真菌性脓毒症患者的中医证候以正虚邪盛为主要特征,中药治疗时注重补虚祛邪,临床疗效值得肯定。
Objective:To summarize the characteristics of Traditional Chinese Medicine(TCM)syndromes in patients with fungal sepsis infections,analyze the rules of TCM formulation through data mining,and evaluate clinical effectiveness,providing a reference for the TCM treatment of sepsis fungal infections.Methods:Clinical data of patients with sepsis admitted to the Intensive Care Unit of Beijing Hospital of Traditional Chinese Medicine from July 1,2007,to July 31,2022,were collected retrospectively.The etiological examination showed fungal infection.Information on patients'general condition,TCM four diagnostic methods,syndrome differentiation types,and use of Chinese herbs were collected.Descriptive statistics were used with frequency.For Chinese herbs,R language was used for frequency statistics and high-frequency herb association analysis,and cluster analysis was performed using SPSS.Analysis of the application of TCM in patients with fungal sepsis complicated by different underlying diseases were performed as well.Clinical effectiveness was evaluated by improvement rate and APACHE II score.Results:A total of 95 patients were included in this study,mainly patients with Candida albicans infection,with an average age of(84.9±11.2)years,including 51 males and 44 females.In terms of infection site,pulmonary fungal infection was the main type.In terms of prognosis,28 day mortality rate of fungal sepsis infection patients was 11.6%.Patients had various underlying diseases,and the main clinical symptoms were fever,cough,asthma,and consciousness disorder.The tongue image was mostly red or pale white tongue with a greasy white coating,and the pulse was mainly thin,string,slippery,and heavy.In terms of syndromes,phlegm-heat obstructing the lung syndrome and Qi and Yin deficiency syndrome were the main clinical syndromes.The application of Chinese herbs mainly focused on bitter-cold and sweet-warm herbs,mainly belonging to the lung,spleen,and stomach meridians,playing a role in supplementing deficiencies,clearing heat and detoxifying,promoting diuresis and resolving phlegm,and promoting blood circulation and removing stasis.Association rule analysis revealed the core drug combinations as Astragalus-Herba angelicae sinensis-Lonicera japonica-Glycyrrhiza uralensis,Cnidium-Sophora flavescens-Dried ginger,Carthamus tinctorius-Atractylodes macrocephala-Tangerine Peel,and Fructus auranti-Tangerine Peel-Bupleurum chinense.Cluster analysis divided high-frequency Chinese herbs into two effective prescription groups,focusing on eliminating pathogenic factors and supplementing deficiencies.Underlying diseases also affected the patient's medication use.Depending on the type of underlying disease,treatment focused on invigorating the heart meridian,clearing the lungs and tranquilizing asthma,soothing and detoxifying the liver,tonifying kidney yang,and invigorating the spleen and drying dampness.The clinical improvement rate was 86.3%,and APACHE II score was significantly lower at discharge than at admission(P<0.05).Conclusion:The main characteristics of TCM syndromes in patients with fungal sepsis are vital energy deficiency and excessive pathogenic factors.The application of treatments is to benefit the vital energy and eliminate pathogenic factors.The clinical effect of TCM treatment is worthy of affirmation.
作者
魏一鸣
胡雅慧
李亚可
徐霄龙
刘清泉
Wei Yiming;Hu Yahui;Li Yake;Xu Xiaolong;Liu Qingquan(Bejing University of Chinese Medicine,Beijing 100029,China)
出处
《中国中医急症》
2024年第7期1139-1144,共6页
Journal of Emergency in Traditional Chinese Medicine
基金
国家中医药管理局高水平中医药重点学科建设项目(ZYYZDXK-2023001)。
关键词
真菌性脓毒症
中医证候
中药组方规律
临床疗效
数据挖掘
Fungal sepsis
Traditional Chinese medicine syndrome
Rules of TCM formulation
Clinical efficacy
Data mining
