Observation On TCM Syndrome Characteristics And Electroacupuncture Efficacy Of Severe-related Delirium

Delirium in critically ill patients occurs and develops in severe diseases of ICU,which is not only the foundation of Critical Care Medicine,but also an important part of Critical Care Medicine.With the development of Critical Care Medicine,more and more attention has been paid to the understanding and management of delirium in critically ill patients.The main management of delirium in critically ill patients include preventive therapy and drug therapy.The drug therapy has been limited clinical application due to the problems of effectiveness and safety,and can not meet the needs of delirium management.Traditional Chinese medicine has advantages in treating delirium,but modern doctors have different understandings of the pathogenesis of severe delirium,so clinical observation of large samples needs to be carried out urgently.The advantages of acupuncture in treating mental diseases can assist in sedation and analgesia of ICU,and its therapeutic effect on delirium needs to be observed urgently.This study consists of two parts:data mining to explore syndrome characteristics and clinical intervention treatment,aiming at exploring syndrome characteristics of delirium in critically ill patients and evaluating the effect,feasibility and curative advantage of electric acupuncture in treating delirium in critically ill patients.Study 1 Analysis of TCM Syndrome Characteristics and Related Factors of Delirium in Critically ? PatientsObjectiveTo explore the characteristic distributions on TCM syndrome elements and TCM syndromes of delirium in critically ill patients,and to analyze the relationship between the TCM syndrome characteristics and the correlative factors of delirium in critically ill patients.MethodsA retrospective and prospective clinical study was conducted to include 218 critically ill patients with delirium.Fill the "TCM Four Diagnostic Information Questionnaire of Delirium".The collected clinical data include general information such as age and sex,basic disease,main diagnosis,Acute Physiology and Chronic Health Evaluation(APACHE-?)and Confusion Assessment Method Intensive Care Unit(CAM-ICU),etc.Applying data mining methods such as factor analysis,cluster analysis and Bayesian network to obtain the TCM syndrome elements of delirium in critically ill patients,and combining TCM theory,literature research and expert experience to explore the regulation of TCM syndromes in delirium.Chi-square test and Pearson coefficient were used to analyze the correlation between different subtypes of delirium,primary disease,APACHE ? and TCM syndrome characteristics of delirium in critically ill patients.Results(1)Calculate the frequency of the TCM four diagnosis information in 218 critically ill patients of delirium,and 38 symptoms,tongue and pulse conditions with frequency?10%were reserved.The most common symptoms were:dyspnea,greasy fur,phlegm-fluid accumulation,coma and delirium,edema,pale tongue,fever,thin pulse,indifferent expression,and dementia,etc.(2)Based on the factor analysis,the cluster analysis and the Bayesian network technology the four diagnostic information were analyzed.The primary nature of pattern elements were qi-desertion,phlegm-dampness,fire-heat,yin-deficiency,yang-deficiency,blood-stagnation,qi-stagnation,blood-deficiency and qi-stagnation,and the primary locations were lung,pleen,kidney,heart,kidney and liver.Eight types of syndromes were obtained:collapse Syndrome,phlegm-fire harassing the spirit,yang deficiency and phlegm dampness,blood stasis,yin deficiency and phlegm heat,phlegm and blood stasis obstructing orifice,qi and yin deficiency,and the syndrome of both qi and yin deficiency and phlegm stasis obstructing orifices.(3)Analyze the distribution of deficiency and excess syndromes of 218 critically ill patients in delirium,excess syndrome accounted for 25.23%,the deficiency syndr ome accounted for 34.86%,and the mixed deficiency and excess syndrome accounted for 39.91%.The distribution of syndromes was as follows:collapse syndrome 18.81%,phlegm-fire harassing the spirit 19.27%,yang deficiency and phlegm dampness 18.35%,blood stasis 6.42%,yin deficiency and phlegm heat 13.76%,phlegm and blood stasis obstructing orifice 9.17%,qi and yin deficiency 6.42%,and the syndrome of both qi and yin deficiency and phlegm stasis obstructing orifices 7.80%.The main syndromes of the hyperative delirium patients were phlegm-fire harassing the spirit,the hypoactive delirium's were collapse syndrom and yang deficiency phlegm-dampness,and the mixed delirium's were yin deficiency and phlegm heat,phlegm-fire harassing the spirit and collapse syndrom.(4)Correlation analysis between TCM syndromes and different subtypes of delirium showed that the main syndromes of the hyperative delirium patients were excess syndrome,the hypoactive delirium were deficiency syndrome and mixed deficiency and excess syndrome.The correlation between primary diseases and TCM syndromes was analyzed.The common syndromes of delirium in respiratory diseases were phlegm-fire harassing the spirit and yang deficiency with phlegm dampness,while what in cardiovascular diseases were phlegm and blood stasis obstructing orifice,collapse syndrome and yang deficiency with phlegm dampness.In the study of the correlation between APACHE ? and the TCM syndromes,the results showed that the APACHE ? score of collapse syndrome was significantly higher than other syndromes,and the APACHE ? score of phlegm and blood stasis syndrome was the lowest.ConclusionFrom the results of epidemiological investigation and data mining,it was inferred that the main TCM syndrome elements of delirium in critically ill patients were qi-desertion,phlegm-dampness,fire-heat,yin-deficiency,yang-deficiency,blood-stagnation.The main TCM syndromes were collapse Syndrome,phlegm-fire harassing the spirit,yang deficiency and phlegm dampness,blood stasis,yin deficiency and phlegm heat,phlegm and blood stasis obstructing orifice,qi and yin deficiency,and the syndrome of both qi and yin deficiency and phlegm stasis obstructing orifices.The distribution of syndromes in different subtypes of delirium and primary diseases was different.The main syndromes of the hyperative delirium patients were excess syndrome,and that mainly were phlegm-fire harassing the spirit.The hypoactive delirium's were deficiency syndrome and mixed deficiency and excess syndrome,and that mainly were collapse syndrome and yang deficiency with phlegm dampness.The distribution of TCM syndromes in mixed delirium was balanced.The common syndromes of delirium in respiratory diseases were phlegm-fire harassing the spirit and yang deficiency with phlegm dampness,while what in cardiovascular diseases were phlegm and blood stasis obstructing orifice,collapse syndrome and yang deficiency with phlegm dampness.Study 2 A Randomized Control Trial of Electric Acupuncture Combined with ABCDEF Bundle Strategy in the Treatment of Delirium in Critically ? Patients.ObjectiveTo observe the clinical effect of electric acupuncture mind-regulating method combined with ABCDEF bundle strategy on delirium in critically ill patients.MethodsIn a prospective,randomized and controlled study,the critically ill patients with delirium were divided into two groups according to the inclusion and exclusion criterion,which were single electric acupuncture group and electric acupuncture combined with ABCDEF bundle strategy group.The total course of treatment was 6 days.Evaluate Intensive Care Delirium Screening Checklist(ICDSC)every day,and Delirium Rating Scale-Revised-98(DRS-R-98)score before and after treatment.Results(1)General information and baseline comparison72 patients were included,including 36 in electric acupuncture group with 4 loss and 36 in control group with 3 loss.Among them,there were 43 males and 28 females,with the average age of 76.96±7.04 years.There was no significant difference between the two groups in sex,age,primary disease,complications,the use of mechanical ventilation,APACHE ?score,and the distribution of subtypes in delirium.(2)Comparison of total delirium timeThere was no significant difference in the total time of delirium between the two groups during treatment(P>0.05).The total time of delirium and sub-delirium in the electric acupuncture group was shorter than that in the control group(P<0.05),and the total time of negative ICSDSC score in the electric acupuncture group was higher than that in the control group(P<0.05).The total time of ICDSC in the electric acupuncture group was longer than that in the control group,and the difference between the two groups was significant(P<0.05).(3)Comparison of ICDSC scoreThere was no statistical difference between the two groups in the dynamic analysis of daily ICSDSC score.After 6 days of treatment,the ICDSC score of the electric acupuncture group was lower than that of the control group(P<0.05).(4)Comparison of cure ratesAlthough there was no significant difference in the overall curative effect between two groups after 6 days of treatment(P>0.05),the cure rate of the electric acupuncture group was higher than that of the control group,and there was a statistical difference between the two groups(P<0.05).(5)Comparison of DRS-R-98 scoreThere was no significant difference in DRS-R-98 score between the two groups before the treatment,but the score of DRS-R-98 in the electric acupuncture group was lower than that in the control group at the end of treatment(P<0.05).There was no significant difference between the two groups(P>0.05).(6)Comparison of different subtypes of deliriumComparing the curative effect of hypoactive delirium between the two groups,the time of negative ICSDSC scres in the electric acupuncture group was longer than that in the control group,and the DRS-R-98 score in the electric acupuncture group was lower than that in the control group after the treatment(P<0.05);There was no significant difference in mixed delirium between groups(P>0.05).(7)Other observation indicatorsThere was no statistical difference between the two groups in the use of sedatives,antipsychotics and analgesics.And there was no significant difference in mechanical ventilation time,ICU mortality,28-day mortality and length of ICU stay between the two groups(P>0.05).Conclusion(1)Electric acupuncture mind-regulating method is effective in treating delirium of critically ill patients,which can shorten the total time of delirium and subclinical delirium,obviously reduce the severity of delirium with good safety.It has better curative effect on hypoactive delirium.(2)Combined electric acupuncture mind-regulating method can not reduce the use of sedative and analgesic drugs,the mechanical ventilation time,the ICU mortality and the 28-day mortality.