The Correlation Between Different Routes Of Infection And TCM Syndromes Of Severe Sepsis With Acute Gastrointestinal Injury (AGI)

Objective Sepsis’s common routes of infection is respiratory infections, urinary tract infections and intra-abdominal infections. Gastrointestinal function is considered to occur with multiple organ dysfunction hub in the course of the evolution of sepsis.This study analyzed the source infected and distribution of TCM Syndromes of patients which had severe sepsis with acute gastrointestinal injury. This study also analyzed the correlation between different sources of infection,TCM Syndromes, PCT, APACHE-Ⅱ score and prognosis. This study provide a reference for the future of medicine in preventing the treatment of severe sepsis.Methods 303 patients were selected which had severe sepsis with acute gastrointestinal injury,and were scorded by APACHE-Ⅱ at 24 hours after hospitalized.Their serum PCT^ Leukocytes, neutrophils, CRP, alanine aminotransferase 、 Cr were mersured immediately after hospitalized. Then to collect four diagnostic data by the basic method of clinical medicine,to fill in CRF table. To refer to " Diagnostics of Chinese Medicine " to complete TCM syndrome by three practitioners together,who one is an attending practitioners, the other two are deputy director of Chinese medicine. Then tracked prognosis of patients.Then to learn the frequency of occurrence and distribution of TCM syndrome, to learn the 28 days after the ICU mortality rate, to learn the length of ICU stay of the survivors by done statistics.And to analysis the correlation between TCM syndrome and APACHE-Ⅱ score, PCT, Cr and prognosis of sever sepsis patients with acute gastrointestinal injury from different routes of infection.Results respiratory infection is up among all routes of infection from 303 cases of acute gastrointestinal injury in patients with sepsis enrolled (195 cases, accounting for 64.36%).The secondly is urinary tract infections (49 cases, accounting for 16.17%), intra-abdominal infection (37 cases, accounting for 12.21%) and blood infection (18 cases, accounting for 5.94%). The minimum is intracranial infection (4 cases, accounting for 1.32%). Air-block type is the most common among the TCM syndrome of all patients (93 cases, accounting for 30.69%). The secondly is weak stomach type (72 cases, accounting for 23.76%), Qi and blood stagnation type and damp-heat intrinsic type (all 64 cases, accounting for 21.12% respectively). And Qi deficiency and blood stasis type,spleen and phlegm type, heat shangyin type are less (total of 10 cases, accounting for 3.30%).In all patients caused by respiratory infections, Air-block type, Qi and blood stagnation type, weak stomach type and damp-heat intrinsic type respectively are 75 cases (accounting for 38.46%),44 cases (accounting for 22.56%),39 cases (accounting for 20.0%) and 28 cases (accounting for 14.36%).And Qi deficiency and blood stasis type,spleen and phlegm type, heat shangyin type are less (4,4,1 cases respectively, accounting for 2.05%,2.05%,0.52%). In all patients caused by urinary tract infections, weak stomach type, Air-block type, damp-heat intrinsic type and Qi and blood stagnation type respectively are 24 cases (accounting for 48.98%) 13 cases (accounting for 26.53%),7 cases (accounting for 14.29%) and 5 cases (accounting for 10.20%). In all patients caused by intra-abdominal infection, damp-heat intrinsic type, Qi and blood stagnation type, weak stomach type, Air-block type are 24 cases (accounting for 64.86%),6 cases (accounting for 16.22%),5 cases (accounting for 13.51%) and 2 cases (accounting for 5.40%) respectively. In all patients caused by blood infection, Qi and blood stagnation type, damp-heat intrinsic type, weak stomach type, Air-block type and heat shangyin type are 8 cases (accounting for 44.44%),5 cases (accounting for 27.78%),2 cases (accounting for 11.11%),2 cases (accounting for 11.11%) and 1 cases (accounting for 5.56%) respectively. In all patients caused by intracranial infection, weak stomach type are 2 cases (accounting for 50%), The other two cases are Air-block type and Qi and blood stagnation type (each accounted for 25.0%). Damp-heat intrinsic type is up among all the patients with septic shock (42 cases, accounting for37.84%). The secondly is Qi and blood stagnation type (25 cases, accounting for 22.52%), Air-block type (23 cases, accounting for 20.72%) and weak stomach type (17 cases, accounting for 15.32%).The other are four cases (accounting for 3.60%). Damp-heat intrinsic type is up among the patients who died within 28 days (34 cases, accounting for 45.33%). The secondly is Qi and blood stagnation type (19 cases, accounting for 25.33%), Air-block type (12 cases, accounting for 16%) and weak stomach type (7 cases, accounting for 9.33%).The other are three cases (accounting for 4%).It is statistically significant differences that APACHE-Ⅱ score, PCT from damp-heat intrinsic type are highest than the others (all P<0.05). It is statistically significant differences that the incidence of septic shock and mortality winthin 28 days from damp-heat intrinsic type are higher than the other (all p<0.05). And it is statistically significant differences that the length of ICU stay of the survivors are longer than the other (all P<0.01). It is statistically significant differences that PCT from Air-block type are higher than from weak stomach type (p<0.05). It is statistically significant differences that APACHE-Ⅱ score, PCT from Qi and blood stagnation type are higher and the length of ICU stay of the survivors from Qi and blood stagnation type are longer than from Air-block type and weak stomach type (P<0.05 or P<0.01).Among the patients from respiratory infections, it is statistically significant differences that APACHE-Ⅱ score, PCT and Cr from damp-heat intrinsic type are highest than the other three types (p<0.05); And it is statistically significant differences that APACHE-II score, PCT from Qi and blood stagnation type are higher than from weak stomach type and Air-block type (all p<0.05). Among the patients from urinary tract infections, it is statistically significant differences that APACHE-II score from Air-block type are higher than from weak stomach type,and lower from Qi and blood stagnation type and damp-heat intrinsic type (all P<0.05);And it is statistically significant differences that PCT from Air-block type are lower than from damp-heat intrinsic type (p<0.05);And it is statistically significant differences that APACHE-II score from weak stomach type are lower than from Qi and blood stagnation type and damp-heat intrinsic type (all P<0.05); And it is statistically significant differences that PCT from weak stomach type are lowest than from the other three types (all P<0.05). Among the patients from intra-abdominal infections, it is statistically significant differences that APACHE-II score from damp-heat intrinsic type are higher than from weak stomach type and Qi and blood stagnation type,and PCT from damp-heat intrinsic type are higher than from weak stomach type,and Cr from damp-heat intrinsic type are higher than from Qi and blood stagnation type (all p<0.05);And it is statistically significant differences that PCT from Qi and blood stagnation type are higher than from weak stomach type (all p<0.05). Among the patients from blood infection, It is statistically significant differences that APACHE-II score, PCT from damp-heat intrinsic type are higher than from Air-block type and weak stomach type (all p<0.05).Conclusion (1) In this group,the patients from damp-heat intrinsic type have the most serious disease and inflammation and the worst prognosis;And the disease and inflammation of the patients from Qi and blood stagnation type are more severe than from Air-block type and weak stomach type,and the prognosis are worse than from Air-block type and weak stomach type; The inflammation of the patients from Air-block type are more severe than from weak stomach type 。 (2) The common TCM syndrome from respiratory infections followed by Air-block type, Qi and blood stagnation type, weak stomach type, damp-heat intrinsic type etc. the disease and inflammation of the patients from damp-heat intrinsic type are most severe than from the others types. The disease and inflammation of the patients from Qi and blood stagnation type are more severe than from Air-block type and weak stomach type.(3) The common TCM syndrome from urinary tract infections followed by weak stomach type and Air-block type, damp-heat intrinsic type,Qi and blood stagnation type etc.The severity of this four types from high to low followed by damp-heat intrinsic type, Qi and blood stagnation type, Air-block type, weak stomach type etc.The inflammation of the patients from weak stomach type are lightest than from the others types. The inflammation of the patients from damp-heat intrinsic type are more severe than from Air-block type.(4) The common TCM syndrome from intra-abdominal infections followed by damp-heat intrinsic type, Qi and blood stagnation type, weak stomach type, Air-block type etc. The disease of the patients from damp-heat intrinsic type are more severe than from Qi and blood stagnation type and weak stomach type. The inflammation of the patients from damp-heat intrinsic type and Qi and blood stagnation type are more severe than from weak stomach type.(5) The common TCM syndrome from blood infection followed by Qi and blood stagnation type, damp-heat intrinsic type, weak stomach type, Air-block type etc. The disease and inflammation of the patients from damp-heat intrinsic type are more severe than from Air-block type and weak stomach type.(6) The more common TCM syndrome from intracranial infection is weak stomach type.The other TCM syndrome from intracranial infection are Qi and blood stagnation type and Air-block type.