| Background:Sepsis with acute kidney injury (AKI) is common to the Intensive Care Unit (ICU) critical illness; it prolongs the patients’hospital stay, increases medical costs, and even is one of the most important reasons of mortality in patients. CRRT, as an important treatment means of sepsis with AKI,:has evident curative effect. It can improve the survival rate and renal function in patients with recovery rate obviously, but a long-term hemodialysis is needed in most of these survivors to maintain their life. Although in recent years, many studies have been done in syndrome of TCM and Dialectical syndromes of sepsis with AKI by numbers of scholars, but there is still few research of CRRT treatment combination with TCM symptoms. Therefore, this study results provide macro basis for optimal time of CRRT treatment based on TCM symptoms.Objective:This study retrospective investigate the characteristic of the ICU patient cases in Guangdong hospital of tradition Chinese medicine, analysis the changes of relevant indicators before and after treatment, combined with the TCM syndrome types, discusses sepsis AKI the relationship between TCM syndrome type with CRRT treatment, provide macro basis for the combination of TCM syndrome type and CRRT treatment.Methods:Here is the clinical data for the sepsis with AKI patients in CRRT treatment in Guangdong hospital of traditional Chinese medicine ICU collected by retrospective survey method, from January2007to December2013(65cases). It records general data, basic diseases, site of infection, general and vital signs, laboratory examination and TCM symptom factors of these patients. SPSS19.0statistical software package is adopted to establish the database in this study, and the data were retrospectively summarized and analyzed. CRRT results before and after treatment using a paired t test, data between the two groups were compared using independent samples T-test, Among the three groups and more than three were compared using variance test, non-normal distribution by using the rank sum test.Results:1. After CRRT treatment, survival rate of these65sepsis with AKI patients was38.46%,17cases of it(68%) were men, women in8cases (32%);Mortality rate was61.54%,28men (70%)and12women (30%); and the ages of them were from29to95, the average age was72.09±12.63, ICU average length of hospital stay was11.84±9.43days, the average number of damaged organs was3.55±1.347, CRRT treatment time was39.52±40.57hours.2. These data were divided into sthenic syndrome group, deficiency syndrome group and deficiency mixed group. Most of them were sthenic syndrome group (67.7%), deficiency syndrome group comes second (18.5%), minimum was deficiency mixed group, only13.8%.3. Comparing generally vital signs before and after treatment, the results showed the sthenic syndrome group of heart rate and breathing rate improved obviously after treatment, after treatment the heart rate is97.56±19.19times/min, significantly lower than before treatment111.50±20.92times/min,P=0.002, the different was ststisically significant. Respiratory frequency became23.80±6.22after treatment times/min, also significantly slowed than before (26.45±5.09times/min),P=0.038, the different was ststisically significant. Deficiency syndrome group only had obviously improve in heart rate, became96.00±15.35times/min after treatment, significantly slower than before119.75±21.87times/min,P=0.007, the different was ststisically significant. Deficiency mixed group cannot improve the indicator of vital signs through CRRT treatment. Compare with the sthenic syndrome group and the deficiency syndrome group, deficiency mixed group has the most significant effect in improving oxygenation didex(P<0.05), the different was ststisically significant. 4. In comparison of before and after the treatment related auxiliary examination, sthenic syndrome group can decrease the procalcitonin (24.20±36.75ng/ml, before treatment, fell to13.18±26.60, after treatment), P=0.002, the different was ststisically significant;and the serum potassium (4.78±1.02tendency/L, before treatment, fell to4.12±0.55432tendency/L, after treatment),P=0.005, the different was ststisically significant;but the other indicators has no obviously improve. Deficiency mixed group can obviously decrease the Urea nitrogen (from41.56±12.13mmol/L, before treatment, fell to25.20±10.20mmol/L, after treatment), P=0.038, the different was ststisically significant;and the Serum creatinine fell to210.00±69.45μmol/L(before treatment) from701.00±443.12μmol/L(after treatment), P=0.013, the different was ststisically significant. Deficiency syndrome group have no positive effect in comparison of related indicators. Com[ared Auxiliary examination among the three groups, the result show that:sthenic syndrome group compared with t deficiency syndrome group, CRP decreased significantly(P<0.05), but compared with the deficiency mixed group difference was not statistically significant(P>0.05). Other indicators were not statistically significant.5. Comparing survival group and death group before CRRT treatment in the independent sample T, the vital signs such as temperature, heart rate, respiratory rate, mean arterial pressure, urine output, ordinary vital signs, and APACHE II score and so on, showed respiratory frequency, unequal variance of urine (P<0.05), are different between these two groups, the rest of the index were homogeneity of variance, and can be compared after CRRT treatment. Results shows that the P value for the above index after treatment were greater than0.05, so it has no statistical significance.Conclusion:1. Most of Sepsis with AKI is reflected as sthenic syndrome in CTM syndrome, and intrinsic phlegm heat syndrome takes the major part, and followed by poisonous evil intrinsic card. The highest survival rate in the three groups of syndrome types is half sthenic half deficiency group, followed by sthenic syndrome group. The lowest is deficiency syndrome group.2. Comparing the curative effect of CRRT treatment, deficiency mixed group is the best, it has the most significant effect in improving oxygenation didex, and compared with before treatment, after treatment can decreases blood urea nitrogen and creatinine, improving renal function. sthenic syndrome group has advantage in slow down the heart rate, breathing rate, reduce the procalcitonin and the serum potassium. Deficiency syndrome group can only improve the heart rate. Therefore, when the related symptoms of sthenic syndrome group are appeared, use CRRT treatment can be helpful. |
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