| Objective:This study hopes that through the review of previous cases,the actual diagnosis rate of sepsis patients can be counted,to find out the basis of clinicians who tend to diagnose,and analyze the relationship between diagnosis and mortality.The compliance of the guidelines for sepsis patients was evaluated,and the clinicians’ knowledge of the sepsis and Western sepsis guidelines was analyzed to summarize the current situation of sepsis diagnosis and treatment,and reverse evaluated whether the guidelines could meet the clinical needs to provide reference for the future clinical diagnosis and treatment work.Method:According to whether the included patients met the diagnostic criteria for Sepsis3.0 and whether the physician clearly diagnosed sepsis/septic shock,they were divided into sepsis diagnosed group,sepsis untreated group and infection group.The population characteristics of the untreated group and the diagnosed group were compared,and they were grouped again according to the admission time to observe whether there was a significant difference in the diagnosis rate in different years.Observe the vital signs and physical and chemical test results of the included patients,and conduct correlation analysis to find out which circumstances clinicians are more inclined to diagnose sepsis and what items are not concerned by clinicians.Statistical analysis of the relationship between the diagnostic yield and the mortality rate.Patients in the diagnosed sepsis group were evaluated for compliance with Western medicine guidelines and scores were made.During hospitalization and application of TCM injections of patients,the diagnosed septic group and the first oral TCM prescription were collected,and compared with TCM guidelines.Result:A total of 752 patients were included,340 in 2019,155 in 2020 and 257 in 2021.There were no significant differences in age,sex,mortality during the hospital,the longest in 2020 and the shortest in 2019,with 26(9,23)and 10(5,24)days,respectively.From 2019 to 2021,the overall diagnosis rate was 22.24%,and the diagnosis rate increased year by year in the three years,from 11.63%to 35.32%.In 2021,the diagnosis rate was significantly increased compared with the previous two years,but the mortality rate was not significantly different.A total of 535 included patients who met the diagnostic criteria for sepsis 3.0,119 in the sepsis group,416 in the sepsis group,and 217 in the infection group,Compare the diagnosed group with the untreated group,Except for more elderly patients in the untreated group than in the undiagnosed group,The proportion of patients in the diagnosed group with comorbidities(95.69%and 99.16%,respectively),multiple infections(57.98%and 41.59%,respectively),and SOFA score[4(2,5)and 6(4,8)respectively],APACHEII score[17(13,22)and 23(13,29)respectively],white blood cell count[9.10(6.28,12.00)and 10.40(6.50,14.00)respectively],hemoglobin(99.57±23.48 and 94.75±23.45,respectively),and albumin[29.85(26.23,32.98)and 28.00(25.20,32.00)respectively],grass transaminase[23.00(17.00,33.65)and 28.20(20.40,52.00)],creatinine[73.25(49.40,133.08)and 109.20(63.00,203.30)],urea[9.13(5.70,14.97)and 12.90(7.02,21.27)],lactic acid[1.75(1.10,2.40)and 2.10(1.50,3.45)],C-reactive protein[34.01(13.99,69.78)and 109.20(20.23,121.61)],procalcitonin[0.25(0.13,0.74)and 0.66(0.21,3.24)]and other indicators.The proportion of invasive ventilator application(6.01%and 37.82%,respectively)were all higher than that of the undiagnosed group by regression analysis,It was concluded that age,albumin,glomerular filtration rate,blood lactate,body temperature,mean arterial pressure,oxygenation index were related with the diagnosis,Of which,blood lactate and body temperature were positively associated with the diagnosis,Age,ALB,eGFR,MAP,and OI were negatively correlated with the diagnosis.The total number of deaths during hospitalization for sepsis diagnosis was 145(27.10%),including 88(21.15%)in the untreated group and 57(47.90%)in the diagnosed group.The mortality rate in the diagnosed group was much higher than that in the undiagnosed group.In terms of the treatment,57.98%patients essentially completed early fluid resuscitation,Retention of the specimens was completed in 82.35%of the patient specifications,98.23%of the patients evaluated antimicrobial de-escalation by repeated sample retention or blood routine review,All patients(100%)with mechanical ventilation were<30mmHg,Glycemic control was better in 94.12%of the patients,For patients with insulin therapy enabled,79.17%had glucose monitoring at 4h/time,In 98.32%of patients,Mechanical or pharmacological methods were applied to prevent venous thrombosis in 81.51%of the patients.Patients eligible for sepsis diagnosis were divided into survival group and death group according to the discharge outcome,with 390 patients and 145 patients in the death group,respectively,significant difference in hospitalization length,SOFA score,and the death group with shorter hospitalization and higher APACHEII score.Compared with the diagnostic rate of the two groups,the diagnostic rate of the survival group was 15.90%and 39.31%.The diagnostic rate of the two groups was significantly different,and the death group was higher.The further analysis of the correlation between the diagnostic rate and mortality showed the link r=0.243,P<0.001,indicating the correlation between the diagnostic rate and mortality,but the degree of association between the two was low.According to the statistics of TCM treatment of patients in the diagnosed group,76.47%of patients had oral TCM treatment,and 80.67%of patients applied TCM injections.The top 10 users of traditional Chinese medicine were licorice,poria cocos,rhubarb,Angelica,gypsum,scutell,atractylodes,ginseng,astragalus and ophiopogon.According to the efficacy classification,the top three types of drugs are tonic deficiency drugs,heat clearing drugs and solution table drugs.The medicinal properties of high-frequency drugs were classified,the highest frequency was cold drugs,the medicinal flavor was classified,the highest frequency was sweet drugs were classified,and the top 4 were lung meridian,spleen meridian,stomach meridian and heart meridian.The top 3 users of TCM injection were ximai injection,Shenmai injection and Xuebijing injection.According to the statistics of the TCM syndrome types in the diagnosed groups,the top five patients were qi and Yin deficiency deficiency syndrome,phlegm and heat syndrome,dampness and heat syndrome,qi and blood deficiency syndrome,and Yin and Yang separation syndrome.Conclusion:① Clinically,it is more inclined to diagnose patients with severe disease and obvious abnormal indicators as sepsis,while patients with little indicators are easy to ignore.The understanding of sepsis is still stuck at the "heavy level",and effective early screening of sepsis cannot be conducted.② The correlation between sepsis diagnosis rate and mortality is not strong,and the prognosis can not be effectively improved through diagnosis,which is related to the lagging overall diagnosis and poor accuracy of diagnostic standards. |
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