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Article(id=1322923153470661187, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.03.032, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339058511, onlineDateStr=2026-10-30, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339058511, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339058511, creator=13701087609, updateTime=1793339058511, updator=13701087609, issue=Issue{id=1322923011518628427, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='3', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1741536000000', pubDateStr='2025-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339024666, creator='13701087609', updateTime=1793340602374, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929628976906432, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929628981100737, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=175, endPage=178, ext={EN=ArticleExt(id=1322923153667793476, articleId=1322923153470661187, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Distribution of TCM Syndromes in Patients with Sepsis-Induced Lung Injury and Related Indicators of Lung Injury，SOFA and APACHE Ⅱ Score, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the correlation of the distribution of TCM syndromes in patients with sepsis-induced lung injury and lung injury-related indicators and sequential organ failure assessment（SOFA），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score.

Methods

Eighty patients with sepsis-induced lung injury admitted to the hospital from January 2022 to January 2023 were selected. The general data，lung injury-related indicators｛arterial oxygenation index（PaO2/FiO2），alveolar arterial oxygen partial pressure difference［P（A-a）O2］｝and SOFA and APACHE Ⅱ scores of the patients were collected. The patients with sepsis-induced lung injury were classified according to the classification criteria of traditional Chinese medicine. The above observation indexes of patients with sepsis-induced lung injury of different types were compared and the correlation was analyzed.

Results

Among the patients with sepsis-induced lung injury，the lung heat obstruction type accounted for the highest proportion［35.00%（28/80）］，followed by the blood stasis type［27.50%（22/80）］，the lung obstruction type［23.75%（19/80）］，and the water retention type［13.75%（11/80）］. There was no significant difference in gender or age among patients with different syndromes（P>0.05）. There were statistically significant differences in PaO2/FiO2 and P（A-a）O2 among patients with different syndromes（P<0.05）. There were significant differences in SOFA and APACHE Ⅱ scores among patients with different syndromes（P<0.05）. There was a significant negative correlation of PaO2/FiO2 and lung heat obstruction，blood stasis obstructing lung，lung congestion and Fu-organ excess，water retention and lung depression（P<0.05），and a significant positive correlation with P（A-a）O2，SOFA score and APACHE Ⅱ score（P<0.05）.

Conclusion

The TCM syndromes of patients with sepsis-induced lung injury are mainly lung heat obstruction，blood stasis obstructing lung，lung congestion and Fu-organ excess，water retention obstructing lung，which are closely related to lung injury-related indicators and SOFA and APACHE Ⅱ scores. Mastering the characteristics of syndrome differentiation of sepsis-induced lung injury and observing the changes of lung injury-related indicators and SOFA and APACHE Ⅱ scores have high value for disease diagnosis，treatment and prognosis evaluation.

, authors=Yun YAN, Jing ZHAO, Fengjiang FAN, Jianying BAO, Jingxin SHI, Bo LI, Yuanhang ZUO, Lixia FENG, authorsList=Yun YAN, Jing ZHAO, Fengjiang FAN, Jianying BAO, Jingxin SHI, Bo LI, Yuanhang ZUO, Lixia FENG, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923154695397963, articleId=1322923153470661187, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

分析脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及序贯性器官衰竭评分（sequential organ failure assessment，SOFA）、急性生理和慢性健康状况Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分的相关性。

方法

选取2022年1月—2023年1月医院收治的脓毒症肺损伤患者80例，收集患者的一般资料、肺损伤相关指标［动脉血氧合指数（ratio of partial pressure of O2 in arterial blood to fraction of inspired oxygen，PaO2/FiO2）、肺泡动脉氧分压差（alveolar-arterial oxygen gradient，P（A-a）O2）］及SOFA、APACHE Ⅱ评分情况，根据中医分型标准对脓毒症肺损伤患者进行分型，比较不同分型的脓毒症肺损伤患者以上各观察指标情况并分析相关性。

结果

脓毒症肺损伤患者以肺热壅痹证型占比最高、35.00%（28/80），其次为瘀血阻肺型27.50%（22/80），肺塞腑实型23.75%（19/80），水饮郁肺型13.75%（11/80）。不同证型的患者在性别、年龄方面差异均无统计学意义（P>0.05）；不同证型的患者肺损伤指标PaO2/FiO2、P（A-a）O2差异均有统计学意义（P<0.05）；不同证型的患者SOFA、APACHE Ⅱ评分差异均有统计学意义（P<0.05）。肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型与PaO2/FiO2呈显著负相关（P<0.05），与P（A-a）O2、SOFA评分、APACHE Ⅱ评分呈显著正相关（P<0.05）。

结论

脓毒症肺损伤患者中医证型主要为肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺，与肺损伤相关指标及SOFA、APACHE Ⅱ评分密切相关，掌握脓毒症肺损伤辨证分型特点并观察患者肺损伤相关指标及SOFA、APACHE Ⅱ评分变化，对疾病诊治及预后评估具有较高价值。

, authors=闫云, 赵璟, 范风江, 包建颖, 史晶心, 李博, 左远航, 冯丽霞, authorsList=闫云, 赵璟, 范风江, 包建颖, 史晶心, 李博, 左远航, 冯丽霞, authorCompany=null, correspAuthors=null, authorNote=

闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

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闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

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闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

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中医证型例数性别（男/女）年龄/（岁）
肺热壅痹2818/1065.79±5.90
瘀血阻肺2214/866.11±6.23
肺塞腑实1913/665.94±5.46
水饮郁肺117/466.05±6.17
χ2/F值0.1310.019
P值0.9890.981
), ArticleFig(id=1322923158109561478, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=CN, label=表1, caption=

不同中医证型的脓毒症肺损伤患者性别、年龄比较

, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型例数性别（男/女）年龄/（岁）
肺热壅痹2818/1065.79±5.90
瘀血阻肺2214/866.11±6.23
肺塞腑实1913/665.94±5.46
水饮郁肺117/466.05±6.17
χ2/F值0.1310.019
P值0.9890.981
), ArticleFig(id=1322923158180864647, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型例数PaO2/FiO2P（A-a）O2
肺热壅痹28202.35±14.20abc127.93±9.65abc
瘀血阻肺22214.56±12.91ab120.38±8.44ab
肺塞腑实19223.18±11.86a113.65±7.19a
水饮郁肺11229.40±13.08107.20±6.13
F值16.53117.410
P值0.0000.000
), ArticleFig(id=1322923158289916552, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=CN, label=表2, caption=

不同中医证型的脓毒症肺损伤患者肺损伤相关指标比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型例数PaO2/FiO2P（A-a）O2
肺热壅痹28202.35±14.20abc127.93±9.65abc
瘀血阻肺22214.56±12.91ab120.38±8.44ab
肺塞腑实19223.18±11.86a113.65±7.19a
水饮郁肺11229.40±13.08107.20±6.13
F值16.53117.410
P值0.0000.000
), ArticleFig(id=1322923158352831113, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型例数SOFA评分APACHE Ⅱ评分
肺热壅痹289.71±1.25abc20.36±1.87abc
瘀血阻肺228.23±1.16ab18.19±1.51ab
肺塞腑实197.51±0.97a16.92±1.27a
水饮郁肺116.89±1.0215.03±1.08
F值24.89243.437
P值0.0000.000
), ArticleFig(id=1322923158432522890, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=CN, label=表3, caption=

不同中医证型的脓毒症肺损伤患者SOFA、APACHE Ⅱ评分比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型例数SOFA评分APACHE Ⅱ评分
肺热壅痹289.71±1.25abc20.36±1.87abc
瘀血阻肺228.23±1.16ab18.19±1.51ab
肺塞腑实197.51±0.97a16.92±1.27a
水饮郁肺116.89±1.0215.03±1.08
F值24.89243.437
P值0.0000.000
), ArticleFig(id=1322923158528991883, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型PaO2/FiO2P（A-a）O2SOFA评分/（分）APACHE Ⅱ评分/（分）
肺热壅痹-0.7240.6910.7520.810
瘀血阻肺-0.6830.6300.6940.782
肺塞腑实-0.6200.5860.6380.733
水饮郁肺-0.5920.5240.5930.625
), ArticleFig(id=1322923158608683660, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923153470661187, language=CN, label=表4, caption=

脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析（r值）

, figureFileSmall=null, figureFileBig=null, tableContent=
中医证型PaO2/FiO2P（A-a）O2SOFA评分/（分）APACHE Ⅱ评分/（分）
肺热壅痹-0.7240.6910.7520.810
瘀血阻肺-0.6830.6300.6940.782
肺塞腑实-0.6200.5860.6380.733
水饮郁肺-0.5920.5240.5930.625
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脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析
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闫云 , 赵璟 , 范风江 , 包建颖 , 史晶心 , 李博 , 左远航 , 冯丽霞
中华中医药学刊 | 国家项目点击 2025,43(3): 175-178
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中华中医药学刊 |国家项目点击 2025 , 43 (3) : 175 -178
脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析
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闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

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闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

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闫云, 赵璟, 范风江, 包建颖, 史晶心, 李博, 左远航, 冯丽霞
作者信息
  • 南阳市第一人民医院脓毒症转化医学重点实验室，河南 南阳 473000
作者简介:

闫云（1982-），女，河南南阳人，副主任中医师，硕士，研究方向：急危重症患者的中西医结合治疗。

Distribution of TCM Syndromes in Patients with Sepsis-Induced Lung Injury and Related Indicators of Lung Injury，SOFA and APACHE Ⅱ Score
Yun YAN, Jing ZHAO, Fengjiang FAN, Jianying BAO, Jingxin SHI, Bo LI, Yuanhang ZUO, Lixia FENG
Affiliations
  • Nanyang Key Laboratory of Sepsis Transformation Medicine of The First People's Hospital of Nanyang，Nanyang 473000，Henan，China
出版时间: 2025-03-10 doi: 10.13193/j.issn.1673-7717.2025.03.032
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摘要
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目的

分析脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及序贯性器官衰竭评分（sequential organ failure assessment，SOFA）、急性生理和慢性健康状况Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分的相关性。

方法

选取2022年1月—2023年1月医院收治的脓毒症肺损伤患者80例，收集患者的一般资料、肺损伤相关指标［动脉血氧合指数（ratio of partial pressure of O2 in arterial blood to fraction of inspired oxygen，PaO2/FiO2）、肺泡动脉氧分压差（alveolar-arterial oxygen gradient，P（A-a）O2）］及SOFA、APACHE Ⅱ评分情况，根据中医分型标准对脓毒症肺损伤患者进行分型，比较不同分型的脓毒症肺损伤患者以上各观察指标情况并分析相关性。

结果

脓毒症肺损伤患者以肺热壅痹证型占比最高、35.00%（28/80），其次为瘀血阻肺型27.50%（22/80），肺塞腑实型23.75%（19/80），水饮郁肺型13.75%（11/80）。不同证型的患者在性别、年龄方面差异均无统计学意义（P>0.05）；不同证型的患者肺损伤指标PaO2/FiO2、P（A-a）O2差异均有统计学意义（P<0.05）；不同证型的患者SOFA、APACHE Ⅱ评分差异均有统计学意义（P<0.05）。肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型与PaO2/FiO2呈显著负相关（P<0.05），与P（A-a）O2、SOFA评分、APACHE Ⅱ评分呈显著正相关（P<0.05）。

结论

脓毒症肺损伤患者中医证型主要为肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺，与肺损伤相关指标及SOFA、APACHE Ⅱ评分密切相关，掌握脓毒症肺损伤辨证分型特点并观察患者肺损伤相关指标及SOFA、APACHE Ⅱ评分变化，对疾病诊治及预后评估具有较高价值。

脓毒症  /  肺损伤  /  中医证型  /  动脉血氧合指数  /  肺泡动脉氧分压差  /  序贯性器官衰竭评分  /  急性生理和慢性健康状况Ⅱ
Objective

To analyze the correlation of the distribution of TCM syndromes in patients with sepsis-induced lung injury and lung injury-related indicators and sequential organ failure assessment（SOFA），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score.

Methods

Eighty patients with sepsis-induced lung injury admitted to the hospital from January 2022 to January 2023 were selected. The general data，lung injury-related indicators｛arterial oxygenation index（PaO2/FiO2），alveolar arterial oxygen partial pressure difference［P（A-a）O2］｝and SOFA and APACHE Ⅱ scores of the patients were collected. The patients with sepsis-induced lung injury were classified according to the classification criteria of traditional Chinese medicine. The above observation indexes of patients with sepsis-induced lung injury of different types were compared and the correlation was analyzed.

Results

Among the patients with sepsis-induced lung injury，the lung heat obstruction type accounted for the highest proportion［35.00%（28/80）］，followed by the blood stasis type［27.50%（22/80）］，the lung obstruction type［23.75%（19/80）］，and the water retention type［13.75%（11/80）］. There was no significant difference in gender or age among patients with different syndromes（P>0.05）. There were statistically significant differences in PaO2/FiO2 and P（A-a）O2 among patients with different syndromes（P<0.05）. There were significant differences in SOFA and APACHE Ⅱ scores among patients with different syndromes（P<0.05）. There was a significant negative correlation of PaO2/FiO2 and lung heat obstruction，blood stasis obstructing lung，lung congestion and Fu-organ excess，water retention and lung depression（P<0.05），and a significant positive correlation with P（A-a）O2，SOFA score and APACHE Ⅱ score（P<0.05）.

Conclusion

The TCM syndromes of patients with sepsis-induced lung injury are mainly lung heat obstruction，blood stasis obstructing lung，lung congestion and Fu-organ excess，water retention obstructing lung，which are closely related to lung injury-related indicators and SOFA and APACHE Ⅱ scores. Mastering the characteristics of syndrome differentiation of sepsis-induced lung injury and observing the changes of lung injury-related indicators and SOFA and APACHE Ⅱ scores have high value for disease diagnosis，treatment and prognosis evaluation.

sepsis  /  lung injury  /  TCM syndrome type  /  arterial oxygenation index  /  alveolar arterial oxygen partial pressure difference  /  sequential organ failure assessment  /  acute physiology and chronic health evaluation Ⅱ
闫云, 赵璟, 范风江, 包建颖, 史晶心, 李博, 左远航, 冯丽霞. 脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析. 中华中医药学刊, 2025 , 43 (3) : 175 -178 . DOI: 10.13193/j.issn.1673-7717.2025.03.032
Yun YAN, Jing ZHAO, Fengjiang FAN, Jianying BAO, Jingxin SHI, Bo LI, Yuanhang ZUO, Lixia FENG. Distribution of TCM Syndromes in Patients with Sepsis-Induced Lung Injury and Related Indicators of Lung Injury，SOFA and APACHE Ⅱ Score[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (3) : 175 -178 . DOI: 10.13193/j.issn.1673-7717.2025.03.032
正文
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脓毒症患者常伴发多器官功能损伤，严重脓毒症患者病死率高达30%～70%，对于危重病患者的研究提示脓毒症发病率15.7%，其中61.1%进一步发展为多器官功能障碍综合征，甚至出现多器官功能衰竭[1]。肺脏是脓毒症病情发展过程中最容易波及的器官，有研究提示脓毒症发生时肺毛细血管内皮损伤，血管通透性增加，大量富含蛋白质的渗出液破坏肺上皮细胞屏障并在肺泡内积聚，使有效通气减少，导致顽固性低氧血症，危及患者生命安全[2-4]。中医学理论认为肺叶娇嫩，外通大气，合皮毛、朝百脉、主治节，且肺气易虚，不耐寒热，淫而易伤[5]。脓毒症肺损伤属于中医“喘证”“暴喘”“喘脱”等范畴，其病机可能为毒邪袭肺，肺失宣肃，痰瘀气滞，肺壅肠闭，肺肾两虚，气不归元等[6]。本研究分析脓毒症肺损伤患者中医证型分布状况与肺损伤相关指标及序贯性器官衰竭评分（sequential organ failure assessment，SOFA）、急性生理和慢性健康状况Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ，APACHE Ⅱ）评分的相关性，为相关诊治工作提供参考信息，现进行总结报道如下。
1　资料与方法
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1.1　一般资料
选取2022年1月—2023年1月医院收治的脓毒症肺损伤患者80例，纳入标准：均符合《脓毒症肺损伤中西医结合诊治专家共识》[7]中疾病诊断标准；成年患者，性别不限；患者和/或患者家属对研究内容知情同意并自愿参与。排除标准：合并免疫系统或免疫缺陷疾病的患者；恶性肿瘤或严重心肝肾功能不全患者；其他病因导致的肺部感染患者；胃肠道出血或有其他出血倾向、凝血功能紊乱的患者。本研究内容符合医院伦理学要求，经过医院医学伦理委员会审核并批准进行。
1.2　方法
收集患者的性别、年龄一般资料，肺损伤相关指标依据入院时检验报告单获取患者的肺损伤相关指标［动脉血氧合指数（ratio of partial pressure of O2 in arterial blood to fraction of inspired oxygen，PaO2/FiO2）］值并如实记录，通过公式计算得到肺泡动脉氧分压差（alveolar-arterial oxygen gradient，P（A-a）O2）值，P（A-a）O2＝［（PB-47）/100×FiO2-PaCO2×1/R］-PaO2，计算公式中：PB为大气压，FiO2为吸入氧浓度，R为呼吸商（一般为0.8），47为水蒸气气压（37℃时），PaO2为动脉血氧分压，PaCO2为动脉血二氧化碳分压。患者入院24 h内进行SOFA、APACHE Ⅱ评分，SOFA评分包括6个条目，呼吸、心血管、肝脏、凝血、肾脏和神经系统各1个条目，每个条目评分为0～4分，最高分24分，评分越高反映器官功能障碍越严重[8]；APACHE Ⅱ评分包括肛温、平均动脉压、心室率、呼吸频次、氧合指数、肌酐、血清钠、血清钾、酸碱度、白细胞计数、红细胞压积等生理指标，根据高于正常范围及低于正常范围等情况依次赋值，总分0～60分，分值越高表明病情越严重[9]。根据《脓毒症肺损伤中西医结合诊治专家共识》[7]《中医诊断学》[10]中医分型标准对脓毒症肺损伤患者进行分型，比较不同分型的脓毒症肺损伤患者以上一般资料、肺功能相关指标及SOFA、APACHE Ⅱ评分情况并分析相关性。
1.3　统计学处理
数据分析采用SPSS 22.0统计软件包，计量资料先进行Shapiro-wilk正态性检验及方差齐性检验，符合正态分布的计量资料采用均数±标准差（）表示，多组计量资料比较采用方差分析，计数资料以频数或比例表示，进行χ2检验，相关性分析采用Pearson相关分析。以P<0.05表示差异有统计学意义。
2　结果
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2.1　中医证型分布状况及一般资料情况分析
脓毒症肺损伤患者以肺热壅痹证型占比最高为35.00%（28/80），其次为瘀血阻肺型27.50%（22/80），肺塞腑实型23.75%（19/80），水饮郁肺型13.75%（11/80）。不同证型的患者在性别、年龄方面差异均无统计学意义（P>0.05）。见表1。
2.2　肺损伤相关指标分析
不同症型的患者肺损伤指标PaO2/FiO2、P（A-a）O2差异均有统计学意义（P<0.05）。见表2。
2.3　SOFA、APACHE Ⅱ评分情况分析
不同症型的患者SOFA、APACHE Ⅱ评分差异均有统计学意义（P<0.05）。见表3。
2.4　中医证型分布状况与肺损伤相关指标及SOFA、APACHE Ⅱ评分的相关性分析
肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型与PaO2/FiO2呈显著负相关（P<0.05），与［P（A-a）O2］、SOFA评分、APACHE Ⅱ评分呈显著正相关（P<0.05）。见表4。
3　讨论
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机体正气不足，外邪入侵，导致毒热、瘀血、痰浊内阻，瘀阻脉络，进而令各脏器受邪而损伤，引发脓毒症[11-12]。《黄帝内经》提出的“治未病”理论，对于脓毒症治疗要旨是在脓毒症初期阶段即截断其病势，防止向重度脓毒症方向发展。脓毒症易伤及肺脏，肺为五脏之一，具有主气司呼吸、主行水、朝百脉、主治节的生理功能，可治理调节肺的呼吸及全身的气、血、津液[13]。有研究指出肺部气血津液功能紊乱是脓毒症肺损伤的重要原因，需要根据患者具体情况进行辨证论治，以获得更佳预后[14-15]。
陈剑明等[16]对脓毒症相关156篇中医证候文献进行总结分析，涉及证候类型共78种，规范后证候类型共54种，录入证候的出现频次共1008次，出现频率大于5%的常见证候类型分别为热毒内盛证、瘀毒内阻证、火热炽盛证、腑气不通证、热毒血瘀证，提示了脓毒症的证候纷繁复杂。本研究中脓毒症肺损伤患者以肺热壅痹证型最为常见，夫肺居膈上，为四脏之盖，若将养过温，或多嗜五辛，热气内搏，肺经壅热，则令人咽干舌燥，膈上烦热，咳嗽壅闷。其次为瘀血阻肺型，脓毒症患者瘀血乘肺，饮聚痰生，阻碍肺气的升降，甚则瘀伤肺络，络损血溢，亦可致心脉不畅，耗伤心气[17]。《灵枢·本神》：“肺气虚，则鼻塞不利，少气；实则喘喝，胸盈仰息。”肺塞腑实型发病考虑肺和大肠互为表里，肺气不宣，肠道功能就会失调，传导功能会失调，这样毒素毒气就会积聚在肠腹里，毒邪内蕴，趁机侵入人体，在机体正气虚弱时损伤络脉，导致脏器受损，阴阳功能、脏腑功能失调。水饮郁肺型基于中医学“肺为水之上源”“肺主治节”“通调水道”等理论，张仲景《金匮要略》中有“水气”“痰饮”等方论，脓毒症肺损伤患者肺气郁闭，宣降失常，水饮停聚。
本研究结果提示肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型与PaO2/FiO2、P（A-a）O2、SOFA评分、APACHE Ⅱ评分均显著相关。PaO2/FiO2是平均动脉血氧分压与室内饱和的比值，可衡量患者的血液氧合情况，也用来衡量患者的呼吸状况。李京宴等[18]的研究表明PaO2/FiO2明显降低是脓毒症患者继发急性肺损伤的独立危险因素。P（A-a）O2是判断肺换气功能正常与否的指标，可用于鉴别低氧血症的原因，判断肺部疾病的严重程度及演变过程[19-20]。研究中不同证型的脓毒症肺损伤患者P（A-a）O2均有不同程度的增高，提示肺本身受累所致氧合障碍。杨晓英等[21]报道脓毒症合并急性肺损伤患者的SOFA评分、APACHE Ⅱ评分均呈高表达状态。SOFA评分包括各主要系统的指标，可以反映出疾病严重程度的差异，而且SOFA评分系统具有客观、简便、数据易于收集、能动态地观察疾病的演变过程的特点[22]。APACHE Ⅱ评分简便可靠，设计合理，预测准确，尤其是危重病患者的病情分类和预后的预测，分值越高，反映病情越重，预后越差，预计病死率越高[23-25]。本研究结果提示肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型与SOFA评分、APACHE Ⅱ评分的相关r值均呈依次降低状况，提示了肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺证型的病情严重程度差异。
综合上述内容可见，脓毒症肺损伤患者中医证型主要为肺热壅痹、瘀血阻肺、肺塞腑实、水饮郁肺，与肺损伤相关指标及SOFA、APACHE Ⅱ评分密切相关，掌握脓毒症肺损伤辨证分型特点并观察患者肺损伤相关指标及SOFA、APACHE Ⅱ评分变化，对疾病诊治及预后评估具有较高价值。
基金
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  • 国家中医药管理局中医药科学技术研究专项(2019ZX7822)
文献
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2025年第43卷第3期
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doi: 10.13193/j.issn.1673-7717.2025.03.032
  • 首发时间：2026-10-30
  • 出版时间：2025-03-10
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国家中医药管理局中医药科学技术研究专项(2019ZX7822)
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    南阳市第一人民医院脓毒症转化医学重点实验室，河南 南阳 473000
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2种不同金属材料的力学参数
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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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