| Objectives:By summarizing and analyzing the characteristics and the dynamic evolution law of TCM syndromes of the sepsis patients in ICU of Guang'anmen Hospital,we hope to understand sepsis more deeply and guide clinical diagnosis and treatment better.And preliminarily summarize the TCM treatment of sepsis patients to lay a foundation for further prospective randomized controlled clinical trials and study on the mechanism of action of prescriptions and medicines in the future.It will also provide data support for the formulation of sepsis TCM diagnostic and therapeutic criteria.Methods:This study intended to use retrospective observation to design a retrospective table of clinical information.On this basis,we collected and recorded the general informa-tion,relevant physical and chemical indicators,scores and the dialectical information and treatment of Chinese medicine on the first day,the fifth to seventh day,the twelfth to fourteenth day,the twenty-sixth to twenty-eighth day(or when leaving ICU)of eligible sepsis patients,and established a clinical database for analysis,induction and summary.Results:1.General characteristics of hospitalized patients:the 97 cases of sepsis included in this study were aged between 51 and 99 years old,of which 81-90 years old pati-ents were the most,accounting for 48.5%of the total number of patients,and the av-erage age of patients was 79.0±8.5 years old.There were 63 males and 34 females,and the ratio of males to females was 1.85:1.The average length of hospitalization was 23.4±8.9 days.The infection sites were mainly in the respiratory system(95.9%).The main underlying diseases were hypertension,coronary heart disease,diabetes mellitus,old cerebral infarction and chronic obstructive pulmonary disease.2.Prognosis of hospitalized patients:In this study,the 28th day mortality rate of the 97 sepsis patients was 27.8%,and the in-hospital mortality rate was 37.1%.There was no significant difference in hospital prognosis between male and female patients,but the average age of death group was higher than that of survival group.There w-ere no significant differences in hospitalization days,leucocyte level,neutrophil ratio,CRP level,PCT level,SOFA score and APACHEE ? score between the two groups.3.The characteristics of TCM syndromes on the first day of hospitalization:The most common TCM syndromes on the first day of hospitalization were pulmonary ob-literation,phlegm-heat,Yin deficiency and Qi deficiency.The top three death rates were heat toxicity(70.0%),Yin deficiency(56.8%)and Yang deficiency(46.2%).Yin deficiency,phlegm-heat and heat-toxin syndrome were the most common symptoms in the death group.The majority of patients in survival group were pulmonary obliteration and phl-egm-heat syndrome.Compared with the survival group,the proportion of heat toxicity and yin deficiency syndrome in the death group was significantly higher,while the pr-oportion of lung closure and phlegm turbidity syndrome in the survival group was si-gnificantly higher than that in the death group.4.The characteristics of TCM syndromes in hospitalized patients during the 5th to 7th day of hospitalization:The most common TCM syndromes in patients during the 5th to 7th day of hospitalization were blood stasis,pulmonary obliteration,phlegm-heat and Qi deficiency.The top three death rates were Yang deficiency(74.1%),water sta-gnation(71.4%)and Yin deficiency(53.3%).The majority of the patients in the death gr-oup were Yang deficiency,blood stasis and Yin deficiency.Qi deficiency,lung closure and phlegm-heat syndrome were the most common symptoms in survival group.Com-pared with the survival group,the proportion of Yang deficiency,Yin deficiency,blood stasis and water stagnation syndrome in the death group was significantly higher,while the proportion of Qi deficiency and phlegm turbidity syndrome in the survival group was significantly higher than that in the death group.5.Characteristic of TCM syndromes in hospitalized patients on the 12th-14th day of admission:The most common TCM syndromes in patients on the 12th-14th day of admission are Qi deficiency and Yin deficiency.The top three death rates were Yang deficiency(66.7%),water stagnation(57.9%)and pulmonary obliteration(57.9%).In the death group,Yang deficiency syndrome was the main syndrome.Qi deficiency syndrome was the main symptom in survival group.Compared with the survival group,the pr-oportion of Yang deficiency,blood stasis,water stagnation and pulmonary obliteration syndrome in the death group was significantly higher,while the proportion of Qi defi-ciency syndrome in the survival group was significantly higher than that in the death group.6.The characteristics of TCM syndromes of hospitalized patients on the 26th-28th day of admission(or when they leave ICU):The most common TCM syndromes of patients on the 26th-28th day of admission(or when leaving ICU)are Yin deficiency and Qi deficiency.The top three death rates were Qi deficiency(68.0%),water stagnation(64.7%)and Yang deficiency(57.1%).The death group mainly suffered from Qi defici-ency,Yin deficiency and Yang deficiency.Yin deficiency and phlegm turbidity were the main symptoms in survival group.Compared with the survival group,the proportion of Qi deficiency,Yang deficiency and water stagnation syndrome in the death group was significantly higher.7.Evolution law of TCM syndromes:For 97 patients with sepsis,Qi deficiency,Yin deficiency,phlegm syndrome and blood stasis were the basic syndromes of sepsis throughout the course of the disease;deficiency syndrome elements showed an upward trend in the whole course of the disease;among the syndrome elements,lung closure,phlegm-heat and heat toxin syndrome showed a downward trend.Phlegm-turbidity syn-drome did not change significantly,and the proportion of blood stasis syndrome fluct-uated in the course of the disease,but it was always more,and the water stagnation syndrome showed an upward trend.For the dead group,the proportion of Yin deficiency syndrome fluctuated,but it was always more,throughout the whole course of the disea-se.The proportion of Qi deficiency and Yang deficiency was on the rise;the proportion of phlegm-heat and heat-toxin syndrome was on the decline as a whole,lung-closure syndrome was on the decline,and in the later period,blood stasis,water stagnation and phlegm turbidity syndrome were on the rise.For the surviving group,the initial stage was mainly based on excess syndromes,and later gradually evolved into the mixture of deficiency and excess.Among the empirical factors,the lung closure and phlegm-heat syndrome showed a downward trend,while the phlegm turbidity,heat toxicity and water stagnation syndrome had little change,and the blood stasis syndrome showed fl-uctuation.Among the deficiency syndrome elements,the proportion of qi deficiency s-yndrome first increased and then decreased,the Yang Deficiency Syndrome slightly in-creased,and the rising trend of yin deficiency syndrome was more obvious.8.Experience in the application of TCM prescriptions and medicines:Through the analysis of complex network,it was concluded that the core drugs of phlegm-heat s-yndrome of sepsis were Pinellia ternata,Apricot kernel,Trichosanthes and Licorice;the core drugs of phlegm-blood-stasis syndrome of lung were Pinellia ternata,Poria cocos,Licorice and Salvia miltiorrhiza;the core drugs of Qi-Yin Deficiency Syndrome were Ophiopogon japonicus,Licorice and Pinellia ternata;the core drugs of Yin-Yang defi-ciency syndrome were Cimicifuga foetida,Angelica sinensis and dried Ginger.The re-presentative prescription of phlegm-heat syndrome was Qing Hua Decoction;the repre-sentative prescription of phlegm turbidity syndrome with Qi deficiency was Liu Jun Zi Decoction,and for those with blood stasis,the representative prescription was Dan S-hen Decoction and Xuan Fu Hua Decoction.For pure phlegm and turbidity,the repre-sentative prescriptions were San Zi Yang Qin Decoction and Di Tan Decoction;the re-presentative prescriptions of heat toxin were Xi Jiao Di Huang Decoction and Si Miao Yong An Decoction;the representative prescription of blood stasis was Dan Shen De-coction;the representative prescription of water stagnation syndrome was Wu Ling Po-wder;the representative prescription of damp-heat syndrome was Xin Jia Da Yuan Po-wder;the representative prescriptions of Qi deficiency syndrome were Liu Jun Zi Dec-oction and Bu Zhong Yi Qi Decoction;the representative prescription of Yin deficiency syndrome was Sheng Mai Powder,and patients with Qi deficiency were treated by Z-hu Ye Shi Gao Decoction,and patients with bowel excess were treated by Zeng Ye D-ecoction;the representative prescriptions of Yang deficiency were Shen Fu Decoction a-nd Si Ni Decoction,and those with Yin deficiency were treated by Ma Huang Sheng Ma Decoction.Conclusions:1.The majority of sepsis patients were elderly.The infection sites were mainly in the respiratory system.Most of them had chronic underlying diseases,most of which were cardiovascular diseases.The mortality rate of sepsis patients was high,and the age of patients was related to the prognosis of hospitalization.The age of death group was higher than that of survival group.2.TCM syndrome typing had a certain value for early identification of patients with poor prognosis of sepsis.In the early stage of sepsis,the specificity of heat toxin syndrome and yin deficiency syndrome was higher.In the middle and late stage,Yang deficiency,blood stasis and water stagnation syndrome were higher,and in the end,Qi deficiency,Yang deficiency and water stagnation syndrome were higher specificity.Cli-nical attention should be paid to the early identification and intervention of the above syndromes.However,the specific application value still needs further research and ver-ification.3.The essence of sepsis was deficiency and pathogenic substance.The overall ev-olution of TCM syndromes was as follows:phlegm-heat blocking lung in the early st-age,phlegm-blood stasis blocking lung in the middle stage,deficiency of both Qi and Yin or deficiency of both Yin and Yang in the late stage,deficiency of both Qi and Yin in the final stage.The evolution of TCM syndromes in the death group was ma-inly phlegm-heat accumulation and toxin-damaging Yin in the early stage,Yin-Yang d-eficiency in the middle stage,phlegm-blood stasis and lung obstruction in the middle stage,Yang deficiency,blood stasis and water stagnation and Qi-Yin Deficiency in the late and stage.Evolution of TCM syndromes in survival group was:phlegm-heat and phlegm-turbidity in the early stage,Qi deficiency and phlegm-blood stasis in the mi-ddle stage,Qi-Yin Deficiency and phlegm in the late stage,and yin deficiency in the final stage.4.The commonly used prescriptions are:phlegm heat:Qing HuaDecoction;phlegm turbidity:Liu Jun Zi Decoction,Xuan Fu Hua Decoction,San Zi Yang Qin Decoction and Di Tan Decoction;heat toxicity:Xi Jiao Di Huang Decoction and Si Miao Yong An Decoction;blood stasis:Dan Shen Decoction;water stagnation:Wu Ling Powder;damp heat:Xin Jia Da Yuan Powder;Qi deficiency:Liu Jun Zi Decoction and Bu Z-hong Yi Qi Decoction;Yin deficiency:Sheng Mai Powder,Zhu Ye Shi Gao Decoction,Zeng Ye Decoction;Yang deficiency:Shen Fu Decoction,Si Ni Decoction and Ma Huang Sheng Ma Decoction.5.The core drugs of phlegm-heat syndrome of sepsis were Pinellia ternata,Apricot kernel,Trichosanthes and Licorice;the core drugs of phlegm-blood-stasis syndrome of lung were Pinellia ternata,Poria cocos,Licorice and Salvia miltiorrhiza;the core drugs of Qi-Yin Deficiency Syndrome were Ophiopogon japonicus,Licorice and Pinellia te-rnata;the core drugs of Yin-Yang deficiency syndrome were Cimicifuga foetida,Angelica sinensis and dried Ginger. |
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