[1]林柏柏,沈梦雯,钱义明,等.从“痰饮”论治脓毒症毛细血管渗漏综合征[J].陕西中医,2021,(2):222-224,238.[doi:DOI:10.3969/j.issn.1000-7369.2020.02.021]
　LIN Baibai,SHEN Mengwen,QIAN Yiming,et al.Treatment of sepsis capillary leakage syndrome from “phlegm and fluid”[J].,2021,(2):222-224,238.[doi:DOI:10.3969/j.issn.1000-7369.2020.02.021]
点击复制

从“痰饮”论治脓毒症毛细血管渗漏综合征
分享到：

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2021年2期
页码:
222-224,238
栏目:
学术探讨
出版日期:
2021-02-05

文章信息/Info

Title:
Treatment of sepsis capillary leakage syndrome from “phlegm and fluid”
作者:
林柏柏1;  沈梦雯2; 钱义明2; 赵 雷 2; 连佳明1; 陈嘉琪1; 孙 旗1; 褚梦瑶1; 钱风华2
(1.上海中医药大学,上海 200080; 2.上海中医药大学附属岳阳中西医结合医院,上海 200437)
Author(s):
LIN Baibai; SHEN Mengwen; QIAN Yiming; ZHAO Lei; LIAN Jiaming; CHEN Jiaqi; SUN Qi; CHU Mengyao; 、QIAN Fenghua
(Shanghai University of Traditional Chinese Medicine,Shanghai 200080,China)
关键词:
脓毒症;  毛细血管渗漏综合征;  痰饮;  病因病机;  辨证施治;  温药;  活血化瘀
Keywords:
Sepsis;  Capillary leakage syndrome;  Phlegm and fluid;  Etiology and pathogenesis;  Syndrome differentiation and treatment;  Warm herbs;  Activate blood and resolve stasis
分类号:
R 631
DOI:
DOI:10.3969/j.issn.1000-7369.2020.02.021
文献标志码:
A
摘要:
脓毒症是急诊及ICU常见的急危重症之一,容易并发毛细血管渗漏综合征(CLS),累及全身多脏器,出现以全身进行性水肿、低血压,低蛋白血症、低氧血症、少尿等为主要临床表现的一种综合征。然现代医学在其治疗上仍无特异性手段,大都是对症支持的综合治疗,并且在液体管理、改善毛细血管通透性、呼吸机机械通气、连续性肾脏替代疗法、调节免疫抑制等疗效方面参差不齐。随着中医药研究水平的不断提高,在治疗脓毒症方面中医药发挥了其独特的优势,本文通过温习中医大量文献,以“痰饮”为切入点,从“虚、饮、瘀”三个证候要素,并且结合现代药理研究角度系统阐述脓毒症并发毛细血管渗漏综合征的病因病机及治疗方法,希冀为临床治疗该病提供新的思路及方向。
Abstract:
Sepsis is one of the most common acute and severe cases in emergency department and ICU.It is easy to be complicated with capillary leak syndrome(CLS),involving multiple organs of the whole body.The main clinical manifestations of sepsis are systemic progressive edema,hypotension,hypoproteinemia,hypoxemia and oliguria.However,modern medicine still has no specific means in its treatment.Most of them are symptomatic and supportive comprehensive treatment,and the curative effects are uneven in liquid management,improvement of capillary permeability,mechanical ventilation of ventilator,continuous renal replacement therapy and regulation of immunosuppression.With the continuous improvement of the research level of traditional Chinese medicine,traditional Chinese medicine has played its unique advantages in the treatment of sepsis.In this paper,through reviewing a large number of TCM literature,taking “phlegm and fluid” as the breakthrough point,from the “deficiency,drink,blood stasis” three syndrome elements,and combined with modern pharmacological research angle,the etiology,pathogenesis and treatment of sepsis complicated with capillary leakage syndrome are systematically expounded in order to provide new ideas and direction for clinical treatment of the disease.

参考文献/References:

[1] 王东强,田永超,李志军.脓毒症诊断的生物学标志物[J].陕西医学杂志,2011,40(3):361-364.
[2] Clarkson B,Thompson D,Horwith M,et al.Cyclical edema and shock due to increased capillary permeability[J].Am J Med,1960(29):193-216.
[3] Ford N,Hargreaves S,Shanks L.Mortality after fluid bolus in children with shock due to sepsis or severe infection:A systematic review and meta-analysis[J].PLoS One,2012,7(8):43953.
[4] 胡 斌,刘 冰,赵浩延,等.中医药治疗脓毒症的研究进展[J].中国医药指南,2020,18(22):32-33.
[5] 刘清泉.对脓毒症中医病机特点及治法的认识[J].北京中医,2007,26(4):198-200.
[6] 韦细连,徐冬雪,杜凤娇,等.“元气亏虚”和“补益元气”在脓毒症发病及治疗中的意义探讨[J].中国中医急症,2019,28(3):479-482.
[7] 赵国桢,郭玉红,李 博,等.中医药防治脓毒症的研究进展[J].中国中药杂志,2017,42(8):1423-1429.
[8] 黄封黎,曹秀秀,张 斌,等.中医辨证分型治疗脓毒症急性肾损伤临床观察[J].内蒙古中医药,2019,38(4):37-38.
[9] 曹 迎,曲志成,姚卫海,等.脓毒症“凝血障碍-血瘀证-活血化瘀”体系研究进展[J].北京中医药,2016,35(11):1091-1095.
[10] 郝 浩,韩 宁,孔 立.益气温阳治疗脓毒症毛细血管渗漏综合征探析[J].中国中医急诊,2018,27(11):1978-1980.
[11] 赵 馥,林新峰,罗苑苑,等.脓毒症患者毛细血管渗漏综合征从“痰饮”论治探微[J].中国现代医生,2013,51(36):110-114.
[12] 陈可冀,史载祥.实用瘀血证学[M].北京:北京人民卫生出版社,1999:107.
[13] 武士锋,赵菁莉,杨洪涛.杨洪涛教授运用附子温阳治疗慢性肾脏病的经验[J].中国中西医结合肾病杂志,2009,10(11):945-947.
[14] 秦伯未.秦伯未医文集[M].长沙:湖南科技学术出版社,1983:85.
[15] 邱泽亮,叶一萍,张 宁,等.参附注射液治疗严重脓毒症临床疗效及对血清 IL-6、IL-10 水平的影响[J].中国中西医结合杂志,2012,32(3):348-351.
[16] Nguyen CT,Luong TT,Lee SY,et al.Panax ginseng aqueous extract prevents pneumococcal sepsis in vivo by potentiating cell survival and diminishing inflammation[J].Phytome dicine,2015,22(11):1055-1061.
[17] 田鲜美,王 玖,任传云,等.参附注射液治疗脓毒性休克(阳脱证)的临床疗效观察[J].北京中医药,2017,36(1):88-91.
[18] Mou ZJ,Lv ZT,Li Y,et al.Clinical effect of Shenfu injection in patients with septic shock:A meta -analysis and systematic review[J].Evid Based Complement Alternat Med,2015(2015):863149.
[19] 郝 浩,孔 立,韩 宁,等.参附注射液对脓毒性休克血流动力学及多糖包被的影响[J].中成药,2017,39(11):2443-2446.
[20] 郝 浩,孔 立,韩 宁,等.参附注射液腹腔注射对脓毒症大鼠肺血管通透性的影响[J].山东医药,2017,57(22):26-27.
[21] 钱义明,何 欣.何立人医论医案选[M].上海:上海科学技术出版社,2018:22-23.
[22] 唐宗海.血证论[M].北京:人民卫生出版社,2005:5.
[23] 蒯伟勇,邹云翔.治水气病十法[J].中国医药学报,1991,6(4):41-42.
[24] 朱世增.时振声论肾病[M].上海:上海中医药大学出版社,2009:89.
[25] 傅文录.时振声治疗肾病方剂学应用的特色[J].辽宁中医杂志,2004,31(8):624-625.
[26] 李 萍,李 洪,贺冬林,等.川芎嗪注射液对小鼠缺血再灌注心肌的保护作用[J].中国医院药学杂志,2006,26(1):32-34.
[27] 高红梅,常文秀,曹书华.“血必净”注射液对内毒素刺激的内皮细胞的影响[J].中国急救医学,2005,25(6):437-438.
[28] 李广罡,韩文斌.血必净注射液对肝脏缺血再灌注损伤的影响[J].现代中西医结合杂志,2009,18(27):3282-3283.
[29] 陈 燕,张劲松,李书清,等.早期活血化瘀治疗脓毒性休克的临床研究[J].临床急诊杂志,2015,16(8):597-602.
[30] 张利鹏,张立彦,王雪芳,等.血必净注射液对毛细血管渗漏综合征血清VEGF、TNF-α、IL-6水平的影响[J].陕西中医,2016,37(9):1209-1210.
[31] 李智泉,王晨虹.云南白药胶囊治疗重度子痫前期毛细血管渗漏综合征[J].中西医结合心脑血管病杂志,2009,7(7):772-773.

相似文献/References:

[1]李 军.大黄附子汤治疗危重脓毒症疗效及对患者胃肠功能改善研究[J].陕西中医,2019,(6):718.
　LI Jun..Research of Dahuang Fuzi prescription in the treatment of patients with severe sepsis improving symptoms signs and gastrointestinal function[J].,2019,(2):718.
[2]荆志强,魏维强,谷 俊,等.通腑宣肺汤对脓毒症急性肺损伤大鼠保护机制的研究*[J].陕西中医,2019,(8):987.
　JING Zhiqiang,WEI Weiqiang,GU Jun,et al.Study on the protective mechanism of the Tongfu Xuanfei decoction in sepsis rats with acute lung injury[J].,2019,(2):987.
[3]张育芳,张 谦△,王忆梅.中医方剂在脓毒症辅助治疗中的辨证应用*[J].陕西中医,2019,(8):1105.
　ZHANG Yufang,ZHANG Qian,WANG Yimei..Dialectical application of traditional Chinese medicine prescription in adjuvant treatment of sepsis[J].,2019,(2):1105.
[4]张吉丹,顼志兵△.健脾消胀方脐部敷贴治疗脓毒症胃肠功能障碍理论研究*[J].陕西中医,2019,(12):1745.
[5]蒋唯松,周与华△,王义辉,等.血必净注射液对EICU脓毒症患者炎症应激反应和心肌功能的影响*[J].陕西中医,2020,(4):502.
　JIANG Weisong,ZHOU Yuhua,WANG Yihui,et al.Effect of Xuebijing injection on inflammatory stress response and myocardial function in patients with sepsis of EICU[J].,2020,(2):502.
[6]王煜辉,董晓斌.脓毒症相关五脏水气病理论探讨[J].陕西中医,2021,(3):353.[doi:DOI:10.3969/j.issn.1000-7369.2020.03.022]
[7]龙 敏,张玉琴,岳 煜,等.黄连解毒汤联合西药治疗脓毒症心肌损伤疗效研究[J].陕西中医,2022,(3):329.[doi:DOI:10.3969/j.issn.1000-7369.2022.03.014]
　LONG Min,ZHANG Yuqin,YUE Yu,et al.Study on clinical efficacy of Huanglian Jiedu decoction combined with western medicine on myocardial injury caused by sepsis[J].,2022,(2):329.[doi:DOI:10.3969/j.issn.1000-7369.2022.03.014]
[8]董学广,傅晓夏,陈秀美,等.解毒通腑泻浊汤保留灌肠对脓毒症合并急性肾损伤患者微循环及血清炎性应激指标的影响[J].陕西中医,2022,(10):1388.[doi:DOI:10.3969/j.issn.1000-7369.2022.10.015]
[9]钟敏林,周仙仕,李 俊,等.血流感染脓毒症患者687例临床特征、中医证素分布及其与预后的相关性分析[J].陕西中医,2022,(10):1392.[doi:DOI:10.3969/j.issn.1000-7369.2022.10.016]
　ZHONG Minlin,ZHOU Xianshi,LI Jun,et al.Clinical characteristics,distribution of TCM syndrome elements and their correlation with prognosis in 687 patients with sepsis and bloodstream infection[J].,2022,(2):1392.[doi:DOI:10.3969/j.issn.1000-7369.2022.10.016]
[10]徐 敏,王建伟.大黄脐贴治疗脓毒症胃肠功能障碍临床研究[J].陕西中医,2022,(11):1531.[doi:DOI:10.3969/j.issn.1000-7369.2022.11.009]
　XU Min,WANG Jianwei.Clinical observation of rhubarb umbilical patch in the treatment of gastrointestinal dysfunction in sepsis[J].,2022,(2):1531.[doi:DOI:10.3969/j.issn.1000-7369.2022.11.009]

备注/Memo

备注/Memo:
基金项目:上海市卫生健康委员会卫生行业临床研究专项(201940205); 上海市卫生健康委员会、上海市中医药管理局中医专项培育项目(04.YY021.16); 上海中医药大学附属岳阳中西医结合医院青年基金资助项目(2019YYQ07)
更新日期/Last Update: 2021-01-28