【摘要】 目的观察舌质舌苔辨证诊疗对脓毒性休克患者微循环的影响。方法对脓毒性休克患者进行舌质舌苔辨证,对同证候患者随机分组,并对治疗组应用中药辨证治疗,分别在确诊时、第24小时、第72小时测定患者的心率、平均动脉压、血乳酸、可溶性细胞间黏附分子-1(sICAM-1)、内皮素-1(ET-1)。结果根据患者舌质、舌苔结合脓毒症病机辨证为阳气暴脱证、毒热内盛证、瘀血阻滞证;对阳气暴脱证应用参附汤治疗,治疗组第24小时平均动脉压显著高于对照组(P<0.01),心率、血乳酸低于对照组(P<0.05),第72小时治疗组平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05);对毒热内盛证应用清营汤合生脉散治疗,治疗组第24小时血清sICAM-1、ET-1含量低于对照组(P<0.05),治疗组第72小时平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量均低于对照组(P<0.05);对瘀血阻滞证应用桃红四物汤加味治疗,治疗组第24小时血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05),第72小时平均动脉压高于对照组(P<0.05),心率、血乳酸、血清sICAM-1、ET-1含量低于对照组(P<0.05)。结论应用舌质舌苔辨证治疗可以改善脓毒性休克患者的微循环,其作用机制可能与降低血管内皮细胞ICAM-1表达,减轻内皮损伤有关。更多还原

【Abstract】 Objective: To study effects of syndrome differentiation and treatment on the basis of tongue diagnosis on microcirculation of patients with septic shock. Methods: Patients with septic shock checked in ICU from January 2012 to June 2013 were differentiated on the basis of tongue nature and fur. Same syndrome patients were randomly divided into 2 groups. Treatment group was given herbal decoction. Survey and record heart rate(HR), mean arterial pressure(MAP),lactate(Lac),soluble intercellular adhersion molecule-1(sICAM-1) and endothelin-1(ET-1) at the time of diagnosis,24th hour and 72th hour. Results:(1)Red or crimson tongue with yellow or without fur(32/91),pale tongue with very little fur(23/91),dark and purplish tongue with white or yellowish fur(19/91) were common,corresponding syndromes of which were intense toxic heat,sudden yang collapse,and blood stasis.(2)After treating patients of sudden yang collapse syndrome with Shenfu Decoction,MAP of treatment group was significant higher(P < 0.01) while HR and Lac were lower than those of control group at the time of 24 h(P < 0.05). MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group(P < 0.05).(3)After treating patients of intense toxic heat syndrome with Qingying Decoction and Shenmai Powder, sICAM-1 and ET-1 were lower than those of control group(P < 0.05) at the time of 24 h;MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group(P < 0.05) at the time of 72 h. ⑷After treating patients of blood stasis syndrome,Lac,sICAM-1and ET-1 of treatment group were lower than those of control group(P < 0.05) at the time of 24h. MAP was higher and HR,Lac,sICAM-1 and ET-1 were lower than those of control group(P < 0.05). Conclusion: Syndrome differentiation and treatment on basis of tongue nature and fur can improve microcirculation of patients with septic shock. The mechanism of that could reduce ICAM-1 expression and endothelial injury.更多还原