Clinical Study On The Distribution Of Tcm Syndromes Of Sepsis And Their Relevant Factors

ObjectiveTo explore the distribution of TCM syndromes of sepsis in ICU;To figure out the relationships between different TCM syndromes and general clinical data,physiological and biochemical indexes and prognosis;To examine the efficacy in the diagnosis of TCM syndromes and judgement of prognosis with those relevant factors,so as to provide theoretical basis and objective guidance for better syndrome differentiation,treatment and prognosis of sepsis in ICU.MethodsIn this study,94 patients with sepsis were retrospectively collected from Hubei Hospital of integrated Chinese and Western Medicine,based on electronic medical record and record room during a period from September 2019 to January 2021.These patients were selected from clinical pathway of sepsis and met the inclusive and exclusive criteria of this research.Their TCM syndromes were determined by 2 Chinese practitioners with abundant experience.Accordingly general clinical data,physiological and biochemical indexes as well as prognosis of those patients were collected and recorded into case report form and Excel with SOFA score and APACHEII score calculated.Finally,with SPSS 22.0 software,distribution characteristics of TCM syndromes of sepsis in ICU would be analyzed.Relationships between TCM syndromes and infectious indexes(WBC,N,PCT),coagulation indexes(PLT,D-D,FIB,APTT,PT),blood gas indexes(PH,Lac,Na,K),SOFA score and APACHEII score would be explored.Efficacy in the diagnosis of TCM syndromes and prejudgement of prognosis would also be evaluated.Results1.General clinical data: Among 94 patients with sepsis,there were 52 males(55.3%)and 42 females(44.7%).Patients’ ages ranged from 46 to 90,with the average at 71.28±13.03 years old.The basic diseases were cardiovascular and cerebrovascular diseases,with 54 cases having hypertension(accounting for 57.4%),44 cerebrovascular diseases(46.8%),28 diabetes(29.8%)and 24 coronary heart disease(25.5%).The most common infection was pulmonary infection in 60 cases(63.8%),followed by combination of pulmonary and urinary tract infection in 12 cases(12.8%),urinary tract infection in 10 cases(10.6%)and abdominal infection in 8 cases(8.5%).2.Distribution of TCM syndromes: The number of blood stasis syndrome,acute dysfunction syndrome,Fu Qi obstruction syndrome and toxic heat syndrome was 28,26,20 and 20,accounting for 29.8%,27.6%,21.3% and 21.3%,respectively.There was no significant difference between distribution of TCM syndromes and sex,but the difference between syndromes and ages was statistically significant(P< 0.05),with the highest average age in acute dysfunction syndrome at 80.7 years old.3.Relationships between TCM syndromes and physiological and biochemical indexes:Among infectious indexes,the levels of WBC,N and PCT were all the highest in Fu Qi obstruction syndrome.However there was no significant difference between TCM syndromes and WBC,N.The difference between syndromes and PCT was statistically significant(P<0.05).Among coagulation indexes,the levels of D-D,FIB,APTT,PT were the highest in blood stasis syndrome.However there was no significant difference between TCM syndromes and PLT,FIB,APTT,PT.The difference between syndromes and D-D was statistically significant(P<0.05).Among blood gas indexes,there was no significant difference between TCM syndromes and Na,K,but the difference between syndromes and PH and lactic acid was statistically significant(P<0.05),with the level of lactic acid in acute dysfunction syndrome the highest.There was significant difference between TCM syndromes and SOFA score and APACHEII score(P<0.05).SOFA score ranged from 4 to 25,with blood stasis syndrome > acute dysfunction syndrome > Fu Qi obstruction syndrome>toxic heat syndrome.APACHEII score ranged from 10 to 34,with acute dysfunction syndrome> blood stasis syndrome>Fu Qi obstruction syndrome>toxic heat syndrome.4.Relationships between TCM syndromes and prognosis: In this study,mortality rate of sepsis within 28 days was approximately40%.There was significant difference between TCM syndromes and prognosis(P<0.05).It was further discovered that prognosis in acute dysfunction syndrome was the worst,statistically worse than that in Fu Qi obstruction syndrome and toxic heat syndrome(P=0.012,P=0.002)but there was no significant difference among other syndromes.5.Efficacy in the diagnosis of TCM syndromes: The efficacy in diagnosing blood stasis syndrome with D-D was the highest,followed by that in acute dysfunction syndrome with lactic acid and Fu Qi obstruction syndrome with PCT.AUC of D-D,lactic acid and PCT was0.842,0.777 and 0.759,respectively.6.Efficacy in the evaluation of prognosis: The efficacy in evaluating prognosis with SOFA score and APACHEII score was equally the highest(AUC=0.805),with APACHEII score having the strongest sensibility(89.5%)and SOFA score having the strongest specificity(75%).By contrast,the efficacy with PCT was the worst(AUC=0.523),with both its sensibility and specificity the lowest.Conclusion1.Cardiovascular and cerebrovascular diseases might be high risk factors for sepsis.2.Advanced ages,high level of lactic acid,high SOFA and APACHEII scores indicate adverse outcomes.3.It is of great significance for diagnosing Fu Qi obstruction,blood stasis syndrome and acute dysfunction syndrome with PCT,D-D and lactic acid respectively.SOFA score and APACHEII score are of high practical value for prognosis of sepsis.4.In an early stage of sepsis,it was relatively common for toxic heat syndrome with favorable outcome,which hardly led to coagulation and metabolism dysfunction,and was suggested to attack the pathogen.In the middle stage,toxic heat syndrome would transform into Fu Qi obstruction,in which combining purgation and tonification was suggested.In the advanced stage of sepsis,it would be frequent to meet blood stasis syndrome and acute dysfunction syndrome with poor grognosis,in which tonifying was suggested.Especially for those patients in ICU,most of them had already progressed into middle or advanced stages with different levels of hypoimmunity or organ dysfunction.Thus supporting and tonifying therapy is suggested to be along with the whole treatment.