ECMO治疗心源性休克患者的中医证型与临床预后指标的相关性分析

Analysis of TCM Syndromes in Patients with Cardiogenic Shock Treated by Extracorporeal Membrane Oxygenation in ICU

摘要: 探讨ICU内使用ECMO治疗的心源性休克患者的中医证候分布规律及与临床预后指标的相关性分析，为中西医结合治疗心源性休克提供参考。方法：回顾性分析2016年1月至2021年5月收治于成都中医药大学附属医院ICU，且使用ECMO治疗的97例心源性休克患者的一般资料、中医证候，并对临床预后指标与中医证型关系进行分析。结果：97例使用ECMO治疗的心源性休克患者中，阳气暴脱证66例(68.04%)，气滞血瘀证19例(19.59%)，气阴两亏证12例(12.37%)。血乳酸水平及APACHE II评分在各组证型中存在差异(P < 0.05)，且在阳气暴脱证与气滞血瘀证之间差异更为显著；各证型间血乳酸水平与APACHE II评分的相关性存在差异(P < 0.05)，其在阳气暴脱证与气滞血瘀证内存在正相关关系，在气阴两亏证内的相关性不具有统计学意义。结论：使用ECMO治疗的心源性休克患者以阳气暴脱证多见，且阳气暴脱证患者血乳酸水平及APACHE II评分较其他证型患者更高。

Abstract: Objective: To explore the distribution of TCM syndromes classification rules in patients with cardiogenic shock treated by ECMO in ICU, and the correlation analysis with clinical prognostic indicators, so as to provide reference for the treatment of cardiogenic shock with integrated traditional Chinese and Western medicine. Methods: The general data and TCM syndromes of 97 patients with cardiogenic shock treated by extracorporeal membrane oxygenation in ICU of the Teaching Hospital of Chengdu University of TCM from January 2016 to May 2021 and the relationship between clinical prognostic indexes and TCM syndrome types was analyzed. Results: There were 66 cases (68.04%) with Yang Qi storm syndrome, 19 cases (19.59%) with Qi stagnation and blood stasis syndrome, and 12 cases (12.37%) with Qi Yin deficiency syndrome. There were differences in blood lactate level and APACHE II score among syndrome types (P < 0.05), and the difference was more significant between Yang Qi storm syndrome and Qi stagnation and blood stasis syndrome. There were di- fferences in the correlation between blood lactate level and APACHE II score among syndrome types (P < 0.05), there was a positive correlation between Yang Qi storm syndrome and Qi stagnation and blood stasis syndrome, and the correlation between Qi and Yin deficiency syndrome was not statistically significant. Conclusion: The patients with cardiogenic shock treated by ECMO were more common with Yang Qi storm syndrome, and the blood lactate level and APACHE II score of patients with Yang Qi storm syndrome were higher than those of patients with other syndrome types.