A TCM Syndrome Analysis Of Diffuse Intravascular Coagulation In Sepsis And A Retrospective Study Of Related Factors

Objectives:1.To evaluate the severity of sepsis correlates with disseminated intravascular coagulation(DIC)by analyze the epidemiological trends,relevance and differences in clinical laboratory indicators and related scores of sepsis correlates with DIC patients.2.To analyze the distribution characteristics of TCM syndromes and elements in sepsis correlates with DIC patients.3.To provide reliable evidence for clinical prospective study by comparing the epidemiology,relevance and differences in related scores among different TCM syndromes in sepsis correlates with DIC patients.Methods:This study was designed using a retrospective case series analysis,to investigate the epidemiological trends,distribution characteristics of TCM syndromes and elements and related influences of sepsis correlates with DIC patients in the ICU of Guang Anmen Hospital for the first time.The patients were selected from January 1st,2011 to December 31th,2016.Data was imported into the SPSS 22.0 software to establish the original clinical database.Statistical analysis was performed to provide reliable evidence for clinical prospective study.Mean±SD is used to describe the data distribution.For categorical data,Chi-square(?2)text was used.If all groups were normal distribution,one-way analysis of variance(ANOVA)was applied to detect differences among groups.Otherwise,comparison within group was detected by nonparametric test.The significance level was defined as 0.05.Results:1.Epidemiological characteristics:In the 210 cases of sepsis correlates with DIC patients,114 cases died(54.3%),96 cases survived(45.7%).Among them,132 cases(62.9%)were male,78 cases were female(37.1%).After 2012,the proportion of males decreased gradually,the proportion of women increased gradually.High incidence age stages were between 61-90 years old,the highest incidence was between 81-90.In the primary disease,the top five were pulmonary infection(58%),urinary tract infection(9%),acute cerebrovascular disease(6%),acute exacerbation of chronic obstructive pulmonary disease(5%),after surgery(5%);other primary diseases included abdominal infection,gastrointestinal bleeding,chronic renal insufficiency,cancer and so on.In the past disease history,the top five were hypertension(15%),coronary heart disease(13%),cerebrovascular disease(12%),renal insufficiency(10%),diabetes(8%),tumor(8%);other past chronic diseases included benign prostatic hyperplasia,pulmonary interstitial fibrosis,bronchial disease,hyperlipidemia and so on.2.Clinical related indicators and scores:There were significant correlations between APACHE,SOFA,ISTH-DIC and JAAM-DIC scores in the 210 cases of sepsis correlates with DIC patients.The APACHE and SOFA score of survival patients were significantly lower than the death.The positive rate of ISTH-DIC score was 38.57%,and the positive rate of JAAM-DIC score was 57.14%.In sepsis-related indicators,WBC,CRP,PCT and LC were higher than the normal range.In DIC-related indicators,APTT,PT,FDP,D-Dimer were higher than the normal range,AT-? was lower than the normal range.All patients were treated with anti-infective therapy and fluid resuscitation actively and timely.57%received low molecular weight heparin anticoagulation therapy;62%received blood replacement therapy;34%received renal replacement therapy;69%received invasive mechanical ventilation,and 36%received non-invasive mechanical ventilation.3.TCM syndromes and elements:In the 186 cases of sepsis correlates with DIC patients,the highest proportion of element combination was two elements combination(72.58%).In the two element combinations,qi deficiency + blood stasis(20.4%),yang deficiency + blood stasis(19.3%),phlegm + heat syndrome(10.2%)were more common.In three elements combination,heat syndrome + yin deficiency + blood stasis accounted for the highest proportion(23.6%).The final main syndromes of sepsis correlates with DIC derived from elements were blood heat injury yin syndrome(44 cases),qi and blood stasis syndrome(38 cases),yang deficiency and blood stasis syndrome(36 cases),phlegm-heat syndrome(19 cases).There were no statistically significant differences in demographic characteristics between the four groups.For APACHE score,yang deficiency and blood stasis group was the highest,phlegm-heat group was the lowest.Qi deficiency and blood stasis group and yang deficiency and blood stasis group were significantly higher than phlegm-heat group(p=0.023;p=0.017).For SOFA score,qi deficiency and blood stasis group was the highest,phlegm-heat group was the lowest.Qi deficiency and blood stasis group and yang deficiency and blood stasis group were significantly higher than blood heat injury yin group(p=0.009;p=0.048)and phlegm-heat group(p=0.006;p=0.03).There was no significant difference between ISTH-DIC and JAAM-DIC score(p>0.05),blood heat injury yin group>yang deficiency and blood stasis group>qi deficiency and blood stasis group>phlegm-heat group.In Chinese medicine treatment,the majority of patients were applied with one decoction(54.3%)or two decoction(26.7%)treatment,the main prescriptions included New Sini Decoction,Qinggan Liangxue Decoction,Shengmai Decoction,Huangqi Chifeng Decoction and so on.Conclusion:1.The incidence of sepsis with DIC was high in elder patients.Male patients were more than female patients,and the proportion of males decreased gradually,while women increased gradually.The mortality rate of sepsis with DIC was increased.The most important primary diseases were pulmonary infection,urinary tract infection and cardiovascular and cerebrovascular disease.2.In sepsis-related indicators,patients' WBC,CRP,PCT and LC were higher than the normal range.In DIC-related indicators,APTT,PT,FDP,D-Dimer were higher than the normal range,AT-? was lower than the normal range.3.In indicators and scores,patients' APACHE ?,SOFA,ISTH-DIC and JAAM-DIC scores were significantly correlated.JAAM-DICwas more sensitive than ISTH-DIC4.In TCM syndromes,the main syndromes were blood heat injury yin syndrome,qi and blood stasis syndrome,yang deficiency and blood stasis syndrome,phlegm-heat syndrome.There were significant differences in APACHE-? score,SOFA score,PT,FIB and FDP among groups.5.In Chinese medicine treatment,for blood heat injury yin patients,nourish yin,reduce heat,relieve toxicity and cool blood was accepted,Qinggan Liangxue Decoction was recommended.For qi deficiency and blood stasis patients,cool blood,active blood,reinforce qi and adjust meridians was accepted,Huangqi Chifeng Decoction was recommended.For yang deficiency and blood stasis patients,save yang,reinforce qi and active blood was accepted,New Sini Decoction was recommended.