The Evaluation Of Sepsis Clinical Pathways Of Integrated Traditional Chinese And Western Medicine And The Syndromes Distribution Rule Of Sepsis

BackgroundSepsis is critical care professional common diseases. Although at present for sepsis treatment developed rapidly, but the morbidity and mortality is still rising.ⅡIness caused by the complexity and critical degree and clinical therapeutic sars-cov poor and treatment costs the higher situation.The development of society caused huge burden. Afer our hospital enable sepsis clinical pathway in August 2009, the standardization of the dialectical treatment has achieved good effect and in mortality, treatment costs get remarkable effect.ObjectivesTo explore septic patients syndromes distribution rule through the retrospective study, and evaluation the Sepsis Clinical Pathways of Integrated Traditional Chinese and Western Medicine on clinical curative effect and health economics.MethodsThrough to guangdong hospital of traditional Chinese medicine, ICL 2008～1010 diagnosed with sepsis 143 patients discharged the search for itsmedical records, TCM syndrome factor again, sums up the syndrome differentiation factor distribution situation and the PACHEⅡscores, the correlation between serum lactic acid level.According to the clinical pathway implementation time, will 143 cases into patients into clinical pathway group and the clinical pathway group, two groups were their respective standard treatments according to western medicine therapy in clinical pathway, the western medicine therapy group based on dialectical circumstance to give general according to Chinese medicine treatment, clinical pathway group based on the western medicine treatment according to the 2009 guangdong hospital of traditional Chinese medicine, sepsis treatment plan to normative expert consensus of TCM syndrome differentiation and treatment. By comparing the two groups of patients 7 days the survival condition, I can with APACHEⅡrating down and three days of serum lactic acid descent clinical pathway treatment efficacy evaluation, meanwhile compared between the two groups of patients hospitalized in the ICU days and treatment costs and to evaluate health economics path.ResultIn the 143 patients mainly for main unionizing syndrome type (inclusion 60.1%), pure 39.9%), empirical accounted for (no 1 patients with simple deficiency syndrome differentiation type as. Disease different stages syndrome type is differ, general septic patients 49 cases, pure of empirical patients, patients with unprotected for inclusion of DGF 28.6 percent; 65 patients with severe sepsis, patients with unprotected 39.6, pure inclusion of 33.8% empirical accounted for; Sepsis shock patients 29), syndrome type of 100 percent for inclusion unionizing.In the basic deficiency syndrome factor, the deficiency of the highest frequency,65.7%, followed for Yang, Yin 30.8% 30.1% 21.0%, hemopenia; Positive basic syndrome factor, sputum card appear frequency tallest, da 74.1, followed by growing 32.9% higher for hot, blood stasis syndrome, water stop card 19.6% 28.0%.For different syndrome factor and serum lactic acid level and I can with APACHEⅡscore, compared wi th hints of average I can with APACHEⅡunionizing inclusion 28.15+5.8 points score than pure empirical groups of patients score 18.9+ I can with APACHEⅡ4.5 points high (P< 0.05). The pat ient appears deficiency syndrome of lactic acid level for mmol/L 3.92+2.68, less appear deficiency syndrome patients mmol/L 1.31+1.47 increased significantly (P < 0.01). Appear Yang syndrome patients lactic acid level, a plus or minus 2.20 bangok does not appear Yang syndrome patients 158+1.03 increased significantly (P<0.01). Path group than seven days for the path 13.3% in death of 27.9 decreased obviously (P< 0.05).Two groups of patients serum lactic acid level after 3 days were significantly drop, path group mmol/for 101+0.81, the path group L 0.89+ 0.68, no significant difference between them (P> 0.05).Two groups of live patientsⅡI can with APACHE 7 days after scores are decreased obviously, path for 9.09+2.65, group compared with the path 10.71 +3.78 decline of more obvious (P< 0.05).Days of hospitalization in the ICU path 8.68+3.03 days, compared with the path 11.38+4.93 reduce group (P< 0.05).Treatment costs in the ICU Path group 23301+12325 yuan, compared with the path 28477+13701 yuan declined obviously group (P< 0.05).Conclusion1. Septic patients with false or true mainly syndromes mingled primarily, therefore treatment in "attack" on both at the same time must be evil "lifter".2. Sepsis the implementation of clinical pathway therapy can improve the prognosis of patients with seven days, reduce mortality rate, reduce APACHEI I grading, especially for patients with severe sepsis, curative effect become more prominent.3. Sepsis ICU patients with clinical pathway can reduce hospitalization days and costs.