摘要
目的探讨中山市重症登革热患者临床特征及中医证型分布规律,为中山市重症登革热患者的早期识别及中医治疗提供理论依据。方法回顾性分析2024年7—10月中山市第二人民医院重症医学科收治的151例重症登革热患者的临床和实验室资料。观察患者的年龄分布、基础疾病情况、临床表现、异常实验室检查占比和中医证型分布。结果151例重症登革热患者年龄>60岁者93例,占比为61.59%;既往有基础疾病者120例,主要基础疾病为高血压(61.67%)、糖尿病(30.00%)和冠状动脉粥样硬化性心脏病(15.83%)。均有发热和乏力的临床表现,其中肌肉酸痛84例(55.63%)、皮疹78例(51.66%)、恶心89例(58.94%)、呕吐63例(41.72%)、腹痛45例(29.80%)、严重出血者81例(53.64%)、休克6例(3.97%)、呼吸衰竭14例(9.27%)、脑炎2例(1.32%)、横纹肌溶解13例(8.61%)、溶血性贫血7例(4.64%)、器官损伤137例(90.73%)。实验室检查血小板(platelet,PLT)<50×10^(9)/L者占56.95%、白细胞(white blood cell,WBC)<4×10^(9)/L者占49.67%。中医证型分成4种,湿热郁遏、卫气同病占32.45%,毒瘀交结、扰营动血占53.64%,余邪未尽、气阴两伤占11.26%,内闭外脱占2.65%。结论老年人及合并有高血压、糖尿病、冠状动脉粥样硬化性心脏病等基础疾病的患者需引起临床关注,PLT减少及严重出血者依然突出,临床还要特别关注患者脏器损伤的情况、横纹肌溶解、溶血性贫血以及早期炎症指标的改变。中医证型以毒瘀交结、扰营动血多见,辨证论治力求寒温统一。
Objective To explore the clinical characteristics and distribution pattern of traditional Chinese medicine syndrome types in severe dengue fever patients in Zhongshan city,and to provide a theoretical basis for the early identification and traditional Chinese medicine treatment of severe dengue fever patients in Zhongshan city.Methods The clinical and laboratory data of 151 patients with severe dengue fever admitted to the department of intensive care medicine of Zhongshan Second People's Hospital from July to October 2024 were retrospectively analyzed.The age distribution,basic diseases,clinical manifestations,the proportion of abnormal laboratory tests and the distribution of traditional Chinese medicine syndromes were observed.Results Among the 151 severe dengue fever patients,93 were over 60 years old,accounting for 61.59%.There were 120 cases with pre-existing underlying diseases,the main underlying diseases were hypertension(61.67%),diabetes(30.00%),and coronary atherosclerotic heart disease(15.83%).All patients exhibited clinical manifestations of fever and fatigue,including muscle pain in 84 cases(55.63%),rash in 78 cases(51.66%),nausea in 89 cases(58.94%),vomiting in 63 cases(41.72%),abdominal pain in 45 cases(29.80%),severe bleeding in 81 cases(53.64%),shock in 6 cases(3.97%),respiratory failure in 14 cases(9.27%),encephalitis in 2 cases(1.32%),rhabdomyolysis in 13 cases(8.61%),hemolytic anemia in 7 cases(4.64%),and organ damage in 137 cases(90.73%).Laboratory tests showed that 56.95%had platelet(PLT)counts<50×10^(9)/L,and 49.67%had white blood cell(WBC)counts<4×10^(9)/L.The TCM syndrome patterns were divided into four types:dampness-heat stagnation with defense and qi phase involvement accounted for 32.45%,toxin and stasis interbinding disturbing the nutrient level and moving blood accounted for 53.64%,residual pathogen remaining with dual deficiency of qi and yin accounted for 11.26%,and internal blockage and external collapse accounted for 2.65%.Conclusion Elderly patients and those with underlying diseases such as hypertension,diabetes,and coronary atherosclerotic heart disease require particular clinical attention.Thrombocytopenia and severe bleeding remain prominent issues.Clinicians should also pay special attention to organ damage,rhabdomyolysis,hemolytic anemia,and early changes in inflammatory markers.In terms of traditional Chinese medicine(TCM)syndrome patterns,toxin and stasis interbinding disturbing the nutrient level and moving blood is the most common pattern.Treatment based on syndrome differentiation should aim to unify the principles of managing cold and warm pathologies.
作者
陈旭
孙达
CHEN Xu;SUN Da(Department of Intensive Care Medicine,Zhongshan Second People's Hospital,Zhongshan Guangdong 528400,China)
出处
《中国卫生标准管理》
2025年第18期25-29,共5页
China Health Standard Management
关键词
重症登革热
临床特征
中医证型
发病机制
辨证论治
诊疗方案
severe dengue fever
clinical features
traditional Chinese medicine syndrome types
pathogenesis
differentiation and treatment of syndromes
diagnostic and treated program
