| Objective:1.To explore the distribution law of TCM syndrome elements in patients with sepsis,and carry out reasonable syndrome differentiation.2.To explore the influencing factors of acute gastrointestinal injury in sepsis.To provide a basis for early clinical identification of high-risk groups and timely intervention in the future.Methods:A retrospective case-control study method was used in this study.According to the inclusion and exclusion criteria,a total of eligible sepsis patients who were admitted to the Intensive Care Unit(ICU)of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to December 2021 were selected 331 cases.Based on previous literature research,collect patient clinical case data,including patient general information(name,gender,age,basic medical history,etc.),physical and chemical indicators(white blood cell count,platelets,procalcitonin,blood creatinine,D-D dimer,etc.),critically ill patient scores(SOFA score,APACHE-Ⅱ score),fluid resuscitation volume within 6 hours of admission,and other clinical data and information from the four diagnosis of traditional Chinese medicine.All the information fill in the case information collection form.Based on the diagnostic criteria of Acute Gastrointestinal Injury(AGI),all enrolled patients were divided into two groups,namely AGI group and non-AGI group,according to whether AGI occurred during hospitalization.Statistical analysis of the two groups of data by using SPSS 21.0 software,and the indicators with significant differences between the two groups were screened out.After screening,the indicators with statistically significant differences were substituted into the binary Logistic regression model for analysis,and the independent risk factors of AGI in patients with sepsis were obtained.In terms of TCM syndrome types,summarizing the distribution of TCM syndrome elements in patients with sepsis to analyze the combination rules of syndrome elements.And explore the relationship between TCM syndrome types and the occurrence of acute gastrointestinal injury in sepsis by grouping patients according to positive syndrome,deficiency syndrome,and deficiency and excess syndromes.Results:1.Basic information of patients: A total of 331 sepsis patients were included in the study,including 201 males(60.7%)and 130 females(39.3%),aged 22-97 years,with an average age of 73.33 years.There were 164 patients(49.5%)in the AGI group and 167(50.5%)in the non-AGI group.2.The results of the distribution of TCM syndrome elements showed that among the331 sepsis patients,62 patients included only positive syndrome elements,accounting for18.7%,and 108 patients only included deficiency syndrome elements,accounting for 32.6%.There were 161 patients with positive and deficient syndrome elements,accounting for 48.7%.Among them,there are 4 common syndrome elements in empirical evidence,among which the most common is phlegm syndrome,accounting for 42.0% of the total sample,followed by toxic heat syndrome,accounting for 29.0%,blood stasis syndrome accounting for 15.1%,and fu-organ syndrome accounting for 5.4% The common syndrome elements of deficiency syndrome include 5,of which the most common is yang deficiency syndrome,accounting for42.0%,followed by qi deficiency syndrome,accounting for 36.6%,yin deficiency syndrome accounting for 33.8%,and blood deficiency syndrome accounting for 13.3%,the gas depletion certificate accounted for 3.0%.Through the determination of TCM syndrome elements,the patients with sepsis included in this study all presented TCM symptoms with a combination of multiple syndrome elements.Among them,there are 264 cases of combination of two syndrome elements.The result of the combination of syndrome elements is: Phlegm syndrome + Yang deficiency syndrome is the most common,a total of 77 cases,accounting for 29.1%;followed by Qi deficiency syndrome+ Yin deficiency syndrome,a total of 49 cases,accounting for 29.1% 18.6%,37 cases of blood stasis syndrome + qi deficiency syndrome,accounting for 14.0%,33 cases of qi deficiency syndrome + blood deficiency syndrome,accounting for 12.5%,31 cases of toxic heat syndrome + phlegm syndrome,accounting for 11.7%;other The proportion of syndrome element combinations decreased in turn.There are 67 cases of the combination of three syndrome elements.The result of the combination of syndrome elements is: Yin deficiency syndrome + Yang deficiency syndrome + poison heat syndrome is the most common,accounting for 70.1%,followed by phlegm syndrome + poison heat syndrome + Fu syndrome,accounting for 26.9%,and Qi deficiency syndrome +Yang deficiency syndrome+Yin deficiency syndrome accounted for 3.0%.The results showed that 6 kinds of syndrome elements were combined,77 cases of phlegm syndrome + yang deficiency syndrome,the composition ratio was 23.3%,49 cases of qi deficiency syndrome + yin deficiency syndrome,the composition ratio was 14.8%,toxic heat syndrome + yang deficiency syndrome Syndrome+ yin deficiency syndrome in 47 cases,the composition ratio is 14.2%,blood stasis syndrome+ qi deficiency syndrome in 37 cases,composition ratio 11.2%,qi deficiency syndrome +blood deficiency syndrome in 33 cases,composition ratio 10.0%,toxic heat syndrome +phlegm syndrome in 31 cases,The composition ratio is 9.4%.3.There are 62 cases with TCM syndrome differentiation as evidence,of which 26 cases(41.9%)have AGI,36 cases(58.1%)have no AGI;there are 108 cases with deficiency syndrome,of which 64 cases(59.3%)have AGI,44 cases(40.7%)did not have AGI;there were 161 cases of syndrome differentiation of deficiency and reality,of which 74 cases(46.0%)had AGI,and 87 cases(54.0%)had no AGI.There was a statistically significant difference in the occurrence of AGI among the three groups(P<0.05).Among the 164 patients with AGI,only 15.9% had TCM syndrome differentiation as evidence,39.0% with deficiency syndrome,and 45.1% with mixed syndrome.4.Grouped according to the severity of the disease,including 140 patients with general sepsis,138 patients with severe sepsis,and 53 patients with septic shock.There was a statistically significant difference in the occurrence of AGI among the three groups(P<0.05).5.The data of the AGI group and the non-AGI group were compared and analyzed,and the results showed that the patients in the AGI group had better history of coronary heart disease,SOFA score,APACHE-Ⅱ score,white blood cell count,lactate,DD dimer,and serum creatinine compared with the non-AGI group.Significant difference(P<0.05).Binary Logistic multivariate regression analysis showed that APACHE-Ⅱ score,lactate,DD dimer,and serum creatinine were not independent risk factors for AGI(P>0.05);previous coronary heart disease history,SOFA score,white blood cell count,pus Toxicity severity and TCM syndrome differentiation were independent risk factors for AGI(P<0.05).The risk of AGI in patients with a history of coronary heart disease was 3.308 times that of patients without a history of coronary heart disease(OR=3.308,95%CI=1.958-5.590);the SOFA score increased by 1 point,and the risk of AGI in patients with sepsis increased 20.7%(OR=1.207,95%CI=1.077-1.353);1 unit increase in white blood cell count increased the risk of AGI in sepsis patients by 4.0%(OR=1.040,95%CI=1.000-1.081);severe pus The risk of AGI in patients with sepsis was 2.279 times that of patients with general sepsis(OR=2.279,95%CI=1.308-3.969);the risk of AGI in patients with septic shock was 2.193 times that in patients with severe sepsis(OR= 2.193,95%CI=1.006-4.784);the risk of AGI was 2.288 times higher than that of positive patients(OR=2.288,95%CI=1.096-4.778).Combined with the history of coronary heart disease,SOFA score,white blood cell count,severity of sepsis,and TCM syndrome differentiation,the diagnostic performance of predicting the occurrence of AGI is good.Conclusions:1.This study shows that the history of coronary heart disease,SOFA score,APACHE-Ⅱscore,white blood cell count,lactic acid,D-D dimer,serum creatinine,severity of sepsis,and TCM syndrome differentiation may be the influencing factors of AGI in sepsis.Among them,the history of coronary heart disease,high SOFA score,high white blood cell count,severe sepsis or septic shock,TCM syndrome differentiation as deficiency syndrome or mixed syndrome of deficiency and excess may be independent risk factors.The results of this study show that the history of coronary heart disease,SOFA score,white blood cell count,severity of sepsis,and TCM syndrome differentiation can be combined to predict the possibility of AGI in patients with sepsis.2.The results of this study show that the TCM syndrome elements of sepsis patients are mostly phlegm syndrome,toxic heat syndrome,yang deficiency syndrome and qi deficiency syndrome.Through the syndrome differentiation of deficiency and excess in patients with sepsis complicated by acute gastrointestinal injury,it can be found that the clinical manifestations of patients with simple empirical symptoms are in the minority,and most of the patients are based on deficiency and actuality,and patients with deficiency syndrome are more prone to AGI. |
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