| 摘要: | 敗血症是危重症病人的主要死亡原因之一，醫學界大量之研究嘗試改善敗血症患者之存活率，但目前仍無有效且經濟之治療方式，所以敗血症之高死亡率仍是令人沮喪的。由於敗血症之病程發展迅速，一個有效且快速評估患者疾病嚴重度與存活率並積極介入治療是相當重要的，本研究運用現行評估敗血症疾病嚴重度與存活率之臨床指標，與研究上報導可預測疾病嚴重度之細胞激素，再加上中醫證型為變數，觀察加護病房中嚴重敗血症與敗血性休克病人，探討臨床指標、細胞激素、中醫證型三種不同類型之變數與死亡的相關性，利用相關性高的變數建立複迴歸模型以評估敗血症患者之預後。另一方面，運用敗血症動物模型，於造型後病程之不同時間點給予參附湯，以評估中藥治療之效應。
本研究完成收案病患計126人，診斷為氣分熱證有46人，營分熱證有51人，血分熱證有45人，血虛證有9人，陰虛證有6人，氣虛證有86人，陽虛證有65人；我們以Log IL-10與陽虛證建立預測模型時，預測率可達73.8%，若以 Log IL-10預測死亡，預測率可達66.7%；若以陽虛證預測死亡，預測率可達71.4%，所以我們認為陽虛證是預測敗血症患者死亡之重要指標，由此可知陽氣衰絕是決定敗血症病患死生的關鍵。另外我們也發現，APACHE II score與CV component是評估敗血症疾病嚴重度與預測死亡之指標，但其效度並不佳，而與死亡相關因子之分析中，男性較女性有較高之風險比；動物試驗方面，參附湯對於敗血症大鼠術後早期與晚期給藥皆能降低死亡率，但無統計上顯著之差異。
Sepsis is the leading cause of death in critical ill patients in intensive care unit. Although, there have been numerous researches and clinical efforts made to improve outcome in patients with sepsis, there is still no effective and economic therapy. So, the achievement was still be disappointed. Due to rapid progression and complicated pathogenesis of sepsis, it’s importment to establish a severity evaluated system practiced and assessed severity of patients easily and rapidly and treate patient immediatedly.
In our study, we evaluated the relationship among clinical tools, cytokines and Chinese medial syndromes and mortality of patients with servere sepsis or septic shock in intensive care unit. Then, we established a logistic regression model for predicting the prognosis of sepsis patients. Moreover, we evaluated the effect of Chinese herbs on septic animal model at different time points.
There were 126 septic patients in our study and 46 were diagnosed Qifen-heat syndrome, 51 diagnosed Yingfen-heat syndrome, 45 diagnosed Xuefen-heat syndrome, 9 diagnosed blood-deficiency syndrome, 6 diagnosed Yin-deficiency, 86 diagnosed Qi-deficiency syndrome, and 65 diagnosed Yan-deficiency syndrome. After analysis, Log IL-10 and Yan-deficiency syndrome were most associated with mortality of septic patients. We selected Log IL-10 and Yan-deficiency syndrome to build a mortality prediction model, and its predictive rate achieved 73.8%. If Log IL-10 was selected alone, the predictive rate was 66.7%. If Yan-deficiency syndrome was selected alone, the predictive rate was 71.4%. We think Yan-deficiency syndrome is a good mortality predicor for septic patients. In addition, the result showed, APACHE II score and CV component are mortality prediction tools for septic patients but the efficacy were not good. Similar with the other researches, the hazard ratio of mortality in male was higher than in women.
The results of the animal experiment showed that the administration of Shen-Fu-tang at 6 hours or 12 hours elevated the survival rate but no significant unfortunately. |
