The Characteristics And Evolution Characteristics Of TCM Syndromes Of Sepsis Caused By Lung Infection

ObjectiveThrough case retrospective study,the evolution characteristics of sepsis caused by pulm onary infection were reviewed from the perspective of integrated traditional Chinese and western medicine.To explore the characteristics of TCM syndrome elements and its evolution of pulmonary infection-induced sepsis by syndrome elements differentiation;To further deepen the understanding of sepsis in traditional Chinese medicine and observe the evolution of "healthy qi" and "evil qi" in the course of disease;The differences of physicochemical indexes in different clinical outcomes were also observed.MethodsA case report form was designed according to the common symptoms of sepsis in the expert consensus on the diagnosis and treatment of sepsis with integrated Chinese an d western medicine and the symptoms and syndrome elements in syndrome differentiation.A total.of 110 cases that met the exclusion criteria were included,and clinical inf ormation was collected at 5 time points(including day 1,3,7,14 and 28 or discharged from hospital).Epidata 3.1 was used to establish the database.In terms of TCM clinical information,TCM symptoms at each time point are converted into syndrome elements according to the method of syndrome element differentiation in syndrome element differentiation,and then all patients at different time points are differentiated according to the method of syndrome element differentiation.SPSS 19.0 statistical software was used to process the symptoms,syndrome elements and syndrome information at different time points,so as to obtain the symptoms,syndrome elements,syndrome distribution and its evolution characteristics of sepsis caused by pulmonary in fection at different time points.Western medicine clinical aspects:information acquisition in patients with different point of physical and chemical indicators,SOFA score,APACHE ? information such as grade,Glasgow.Patients were divided into survival and death groups according to 28-day outcomes.SPSS 19.0 statistical software was used to analyze whether there were differe nces in biochemical indexes and scores of patients with different outcomes at different time points.Results1.5 distribution of major syndromes in patients at time points(those accounting for more than 10%)The first time point(the first day after enrollment):the main disease loci were lung,spleen,mind,kidney,surface,meridian,stomach and heart;The main pathogenic elements are phlegm,qi deficiency,heat,Yin deficiency,blood deficiency,dampness,Yin deficiency,Yang deficiency,shutdown,blood heat,qi depression and toxin.The second time point(the third day after enrollment):the main disease loci were lung,spleen,mind,kidney,meridian and heart;The main disease syndromes are qi deficiency,phlegm,Yin deficiency,blood deficiency,heat,dampness,Yin deficiency,Yang deficiency,qide pression and shut-down.The third time point(the 7th day after enrollment):the main disease loci were lung,sp leen,mind,meridian and kidney.The main pathogenic elements are qi deficiency,phlegm,blood deficiency,Yin deficiency,dampness,heat,Yin deficiency,Yang deficiency,shut-dow n and qi depression.The fourth time point(the 14th day after enrollment):the main disease loci were lung,spleen,mind,meridian and kidney.The main disease syndromes are qi deficiency,phlegm,blood deficiency,dampness,Yin deficiency,heat,Yang deficiency,qi depression,shut-down and shut-down.The fifth time point(the 28th day after enrollment or discharged from hospital):the m ain disease loci are lung,spleen,mind,meridian and kidney.The main pathogenic elements are qi deficiency,phlegm,blood deficiency,Yin deficiency,Yin deficiency,heat,dampness,shut-down and Yang deficiency.2.5 distribution of main syndromes of patients at time points(syndrome accounting for more than 10%)The first time point(the fist day after enrollment):phlegm-heat obstructing the lung,p hlegm-heat disturbing the mind,spleen-deficiency qi depression,spleen-deficiency blood deficit,lung-spleen qi deficiency,lung-spleen qi deficiency,lung-health deficiency,lung-qid eficiency and phlegm-obstruction.The second time point(the third day after enrollment):phlegm-heat obstructing lung,sp leen-deficiency blood deficiency,phlegm-qi deficiency and phlegm-qi depression,heat of lung,phlegm-heat disturbing god,phlegm-mind-mind-clearing,phlegm-turbidity obstructing lung.The third time point(the 7th day after enrollment):lung qi deficiency and phlegm obst ruction,spleen deficiency and blood deficiency,phlegm-heat obstructing lung,spleen deficiency and qi depression,heart qi deficiency and blood deficiency,qi and blood deficiency,phlegm turbidity obstructing lung.The fourth time point((the 14th day after enrollment):spleen deficiency and blood loss,lung qi deficiency and phlegm obstruction,phlegm mind-clearing,phlegm-heat obstructing lung,spleen deficiency and qi depression,kidney Yang deficiency and water stagnation,qi and blood deficiency,phlegm turbidity obstruction and lung,spleen deficiency and Yin stagnation.The fifth time point((the 28th day after enrollment or discharged from hospital):lung qi deficiency and phlegm obstruction,spleen deficiency and blood deficit,qi and blood deficiency and phlegm turbidity obstruction of lung.3.Syndrome evolution characteristics of sepsis caused by pulmonary infection.In the development process of sepsis caused by pulmonary infection,there is always the feature of "the battle between good and evil".In the early stage of the disease,"patho genic deficiency" is the main manifestation,which can be seen in obvious syndromes such as phlegm-heat syndrome,heat-toxin syndrome,surface syndrome,heat disturbance of the mind,heat trapping pericardium,etc.At the same time,there are also factors of "deft ciency of vital energy",but the "deficiency of vital energy" at this time is mainly man ifested as deficiency of vital energy and deficiency of blood,which accounts for a small proportion.Day 1-7 is the period of intense competition between good and evil,and evil gas gradually enters into the blood.At this time,the main syndromes are the phl egm-heat obstructing lung syndrome,the heat toxic heat sheng syndrome,the heat sheng moving blood syndrome,and the phlegm-heat disturbing god syndrome.At the same time,the degree of the phlegm-heat deficiency is gradually aggravated,and the syndrome of qi Yin deficiency and jin deficiency gradually appears.14 days in the mid and late pay for good and evil,table card basic disappearance,pathogenic factors in the struggle between good and evil tends to smooth,ill sex still is given priority to with factors,p hlegm heat,proportion of toxic heat,blood,etc)symptoms,fewer but phlegm turbidity,ph legm syndrome still exist,such as wet and spleen kidney Yang deficiency in stop facto rs such as water drink syndrome.On the 28th day,in the later stage of the disease course,the proportion of syndromes such as phlegm heat and heat toxicity showed a down ward trend,and the proportion of "deficiency of positive energy" increased.The deficien cy of qi and blood and Yin and Yang deficiency were the main manifestations.From t he perspective of viscera,it gradually affected the spleen and kidney.4.Statistical analysis of biochemical indexes and scoring in western medicine:Platelet count(PLT):at day 14,day 28,or discharge,there was a significant difference in the mean PLT between the survival and death patients(P=0.003,P=0.003,all<0.05).C-reactive protein(CRP):on day 3,day 7,and day 14,the mean CRP values of survival patients and death patients were significantly different(P=0.018,P=0.012,P=0.013,all<0.05).Urea nitrogen(BUN):on the first day,the third day,the 28th day or when discharged from hospital,the mean BUN values of the survival and death patients were significantly different(P=0.005,P=0.016,P=0.000,all<0.05).White blood cell count(WBC):on day 28 or after discharge,there was a significant dif ference in the mean WBC between patients who survived and those who died(P=0.000<0.05).Serum albumin(ALB):at day 1,day 3,day 14,and day 28,or at discharge,there were sig nificant differences in the mean ALB values between the survival and death patients(P=0.006,P=0.003,P=0.00,P=0.001,all<0.05).SOFA score:at day 1,day 3,day 7,and day 28,or after discharge,there were significant differences in the mean SOFA score between the survival and death patients(P=0.002,P=0.006,P=0.03,P=0.000,all<0.05).APACHE ? rating:1 day,3 days,days 14 and 28 days or discharged from hospital sur vival and death in patients with APACHE ? scoring average has significant differenc e(P=0.042,P=0.011,P=0.017,P=0.000,<0.05).Glasgow scores on day 28 or at discharge show a significant difference between the Glasgow scores of survival and death patients(P=0.000<0.05).Conclusions1.Sepsis caused by pulmonary infection involves a wide range of disease locations,complicated diseases and diverse syndromes.Lung,spleen,kidney and spirit are the main di seases,and phlegm,heat,toxin,dampness,decoction,qi deficiency,blood deficiency and Yin deficiency are the main diseases.Qi deficiency and phlegm are the main pathogenic factors throughout the course of the disease.2."Competition between good and evil" runs through the whole course of sepsis cause d by pulmonary infection,and "evil spirits" persist."deficiency of vital qi" plays an important role in the whole course of disease,and the relationship between"decline and gro wth of positive and evil spirits" determines the prognosis of patients.Therefore,in the whole course of treatment,there should be the consciousness of "strengthening and eli minating evil".3.Physicochemical indexes of western medicine:PLT,CRP,BUN,ALB and WBC can all indicate the prognosis of patients.However,WBC indicated worse prognosis than PLT,CRP,BUN and ALB.Scoring:SOFA score,APACHE ? grading and prognosis of patients with Glasgow score could prompt,but the value of the Glasgow score with SOFA score and APACHE ? high score.