【摘要】 【目的】探讨ICU获得性肌无力（ICUAW）的不同中医证型与临床预后的相关性。【方法】采用回顾性队列研究方法，比较ICUAW不同证型患者入住ICU第28、90天功能独立性量表（FIM）运动功能评分、复合终点事件发生风险以及入住ICU第28、90天生存状态的差异。【结果】（1）在FIM运动功能评分方面，入住ICU第28天，肺热津伤证比脾胃虚弱证的FIM运动功能评分高21.95倍[95%CI(7.71,36.19)]，差异有统计学意义（P<0.01）；而湿热浸淫证与脾胃虚弱证比较，差异无统计学意义（P>0.05）。入住ICU第90天，不同中医证型ICUAW患者的FIM运动功能评分比较，差异无统计学意义（P>0.05）。（2）在复合终点事件发生风险方面，入住ICU第90天，湿热浸淫证比脾胃虚弱证复合终点事件发生风险低87.27%[95%CI(0.030 4,0.533 7)]，差异有统计学意义（P<0.01）；而肺热津伤证与脾胃虚弱证比较，差异无统计学意义（P>0.05）。（3）在生存状态方面，入住ICU第28天，2种模型中，肺热津伤证、湿热浸淫证与脾胃虚弱证比较，差异均无统计学意义（P>0.05）。入住ICU第90天，在Crude模型中，肺热津伤证比脾胃虚弱证发生死亡的风险低73.72%[95%CI(0.075 4,0.915 5)]，湿热浸淫证比脾胃虚弱证发生死亡的风险低83.24%[95%CI(0.038 0,0.738 0)]，差异均有统计学意义（P<0.05）；在校正混杂因素后的模型Ⅰ中，肺热津伤证和湿热浸淫证患者发生死亡的风险也均有低于脾胃虚弱证的趋势，但差异均无统计学意义（P>0.05）。【结论】脾胃虚弱可能是ICUAW患者预后差的主要中医病机。更多还原

【Abstract】 Objective To investigate the correlation of traditional Chinese medicine(TCM)syndrome types with the clinical prognosis of intensive care unit acquired weakness(ICUAW). Methods A retrospective cohort study was carried out in the ICUAW patients hospitalized in the intensive care unit(ICU),and the differences in the motor function scores evaluated with functional independence measure(FIM)on ICU hospitalization day 28 and 90,risk of composite endpoint events on day ICU hospitalization 90, and survival status of the ICUAW patients with different syndromes on ICU hospitalization day 28 and 90 were compared. Results(1)The FIM motor function scores in ICUAW patients with lung heat consuming fluid syndrome on ICU hospitalization day 28 were 21.95 times higher than those in ICUAW patients with deficiency of spleen and stomach syndrome [95% CI(7.71,36.19)],the difference being statistically significant(P<0.01). However, the differences of the motor function scores in ICUAW patients were not statistically significant between excessive damp-heat syndrome and deficiency of spleen and stomach syndrome(P>0.05). On ICU hospitalization day 90,there was no statistically significant differences presented in the FIM motor function scores among ICUAW patients with various TCM syndrome types(P>0.05).(2)The risk of composite endpoint events in ICUAW patients with excessive damp-heat syndrome was 87.27%[95% CI(0.030 4,0.533 7)] lower than that in ICUAW patients with deficiency of spleen and stomach syndrome on ICU hospitalization day 90,the difference being statistically significant(P<0.01). However,the difference of the risk of composite endpoint events in ICUAW patients was not statistically significant between lung heat consuming fluid syndrome and deficiency of spleen and stomach syndrome(P>0.05).(3)In terms of survival status,no significant difference was presented among ICUAW patients with lung heat consuming fluid syndrome,excessive damp-heat syndrome and deficiency of spleen and stomach syndrome(P>0.05)on ICU hospitalization day 28 analyzed by the Crude model and model Ⅰ. On ICU hospitalization day 90,the analysis with the Crude model showed that the risk of death in ICUAW patients with lung heat consuming fluid syndrome was 73.72% [95%CI(0.075 4,0.915 5)] lower than that in ICUAW patients with deficiency of spleen and stomach syndrome,and the risk of death in excessive damp-heat syndrome was 83.24% [95%CI(0.038 0,0.738 0)] lower than that in deficiency of spleen and stomach syndrome,the difference being statistically significant(P<0.05). The analysis with the model Ⅰ after correction for confounding factors showed that the risk of death in ICUAW patients with lung heat consuming fluid syndrome and excessive damp-heat syndrome tended to be lower than that in ICUAW patients with deficiency of spleen and stomach syndrome, the differences being not statistically significant(P>0.05).Conclusion Spleen and stomach deficiency may contribute to the primary TCM pathogenesis of ICUAW patients with poor prognosis.更多还原