Analysis Of Influencing Factors And Characteristics Of TCM Syndromes Of Septic Shock Complicated With Paralytic Ileus

Research PurposeObjective to investigate the incidence and risk factors of paralytic intestinal obstruction in patients with septic shock.To analyze the characteristics of TCM syndromes of septic shock patients complicated with paralytic ileus.In order to provide a reference basis for the clinical prevention and treatment of septic shock complicated with paralytic ileus.Research MethodsThis study retrospectively analyzed 162 patients with septic shock admitted to the intensive care department of the Hospital of Chengdu University of TCM from January 2019 to January 2021,collecting the general clinical data,laboratory indicators and information of four diagnostic methods of TCM.All the patients were divided into two groups according to whether they were complicated with paralytic ileus,and the following analyses were made:(1)Through univariate analysis,the relevant indexes of septic shock patients complicated with paralytic ileus were screened.The independent risk factors of septic shock complicated with paralytic ileus were screened by multivariate Logistic regression analysis.(2)ROC curve was used to evaluate the predictive efficacy of the screened independent risk factor continuous variables for septic shock complicated with paralytic ileum obstruction.Finally,the AUC under the curve was analyzed to quantitatively describe the predictive efficacy evaluation results.The optimal cut-off point values,sensitivity and specificity of risk factors were determined in ROC curve analysis.(3)The Kaplan-Meie method was used to compare the mortality rates between the septic shock group and the septic shock group complicated with paralytic ileus,and to explore the differences in the mortality rates at the 28th and 90th days between the two groups.(4)The characteristics of TCM syndromes in the two groups were analyzed,and the differences in TCM syndromes distribution were compared by non-parametric test.P<0.05 was considered statistically significant.Results1.In univariate analysis,there were statistical differences in the maximum norepinephrine dosage within 24h in the two groups of patients;Among the underlying diseases,hypertension,type 2 diabetes mellitus and chronic heart failure were statistically different(P<0.05).2.Binary Logistic regression analysis showed that the maximum norepinephrine dosage within 24 hours in patients with chronic heart failure PCT BNP was positively correlated with patients with septic shock complicated with paralytic ileum obstruction;Type 2 diabetes mellitus and K~+were inversely associated with paralytic ileus in septic shock patients.3.ROC curve showed that the maximum dose of noradrenaline within 24 hours of K~+、PCT、BNP could predict the risk of septic shock patients complicated with paralytic intestinal obstruction.When univariate prediction was made,the area under the ROC curve was 0.7181、0.7525、0.6486、0.6767,among which PCT had the best prediction effect.The cut-off value analysis showed that K~+was 3.255mmol/L,PCT was 1.675ng/m L,BNP was 3135pg/m L,and the maximum dose of norepinephrine within 24h was 0.52ug/kg/min.4.Kaplan-Meier method showed that there were significant differences in mortality between the two groups on the 28th and 90th day,and the mortality of septic shock complicated with paralytic ileus group was higher than that of septic shock group at any time point(Log-rank P<0.05).5.The patients in septic shock group had more Qi Yin exhaustion syndrome than those in septic shock complicated with paralytic intestinal obstruction group.The patients in septic shock complicated with paralytic intestinal obstruction group had less Qi Yin exhaustion syndrome,Yang Qi outburst syndrome and viscera deficiency,and both yin and yang deficiency syndrome than those in septic shock complicated with paralytic intestinal obstruction group.There were differences in mortality among the three types of syndrome,but the difference was not statistically significant(P>0.05)。Conclusions1.Septic shock patients had a high incidence of paralytic ileus,which was37.04%in this study.2.Chronic heart failure、PCT、BNP may be the risk factors for septic shock patients complicated with paralytic ileus,and type 2 diabetes、K~+may be protective factors for septic shock patients complicated with paralytic ileus.3.The maximum dose of norepinephrine within 24 hours、K~+、PCT、BNP、can predict the risk of paralytic ileus in patients with septic shock,and PCT has the best predictive effect.4.Patients with septic shock complicated with paralytic ileus had a higher mortality rate than those in the septic shock group,both at day 28 and day 90.5.Differences between two groups of patients with TCM syndrome type distribution,The patients in septic shock group had more Qi Yin exhaustion syndrome than those in septic shock complicated with paralytic intestinal obstruction group.The patients in septic shock complicated with paralytic intestinal obstruction group had less Qi Yin exhaustion syndrome,Yang Qi outburst syndrome and viscera deficiency,and both yin and yang deficiency syndrome than those in septic shock complicated with paralytic intestinal obstruction group.