A study on distribution characteristics of traditional Chinese medical syndromes of emergency sepsis / 中国中西医结合急救杂志

ABSTRACT

Objective To explore the distribution characteristics and regularity of traditional Chinese medical (TCM) syndromes in patients with sepsis in Department of Emergency of our hospital by enalyzed their clinical data and TCM four clinical diagnostic information so as to provide the basis for TCM standardized diagnosis and treatment of sepsis. Methods From July 2016 to October 2017, 135 patients with sepsis were admitted to the Department of Emergency and Department of Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhejiang Chinese Medical University, 110 cases in sepsis group, 25 cases in sepsis shock group. An unified questionnaire was developed to collect the patients' general data, infection site and TCM four clinical diagnostic information (TCM syndromes, tongue coating, pulse signs, etc.) for dialectical typing on the day of admission with definite diagnosis, the relevant laboratory examinations were completed within 24 hours after the confirmative diagnosis was made, and the quick sequential organ failure assessment (qSOFA) and SOFA scores were calculated. Results In 135 cases of sepsis, pulmonary infection (51.9%) was the main one, followed by abdominal infection (25.9%). The distribution of TCM syndromes the toxic heat syndrome was the main syndrome in sepsis group (61.8%) and acute deficiency syndrome was the main syndrome in sepsis shock group (68.0%), the difference between the two groups being statistically significant (P < 0.001). There were no statistical significant differences in comparisons of infection related indicators between sepsis and septic shock groups, different TCM syndromes of sepsis (all P > 0.05), such as white blood cell count (WBC), percentage and absolute value of neutrophils, C-reactive protein (CRP), procalcitonin (PCT). the lactic acid in patients of the acute deficiency syndrome was significantly higher than those in patients of the toxic heat syndrome, the stoppage of the qi of the bowels syndrome and blood stasis syndrome [mmol/L 2.8 (1.5, 4.2) vs. 1.3 (1.0, 1.8), 1.6 (1.3, 3.8), 1.6 (1.2, 2.9), P < 0.001], and in septic shock group was significantly higher than that in the sepsis group [mmol/L 4.0 (2.7, 5.7) vs. 1.4 (1.1, 1.9), P = 0.000]. The rate of qSOFA ≥ 2 score was 25.5% (28/110) in sepsis group, and 80.0% (20/25) in sepsis shock group, the difference being statistically significant (P < 0.001); while the rate of qSOFA ≥ 2 score was 69.4% (25/36) in patients of acute deficiency syndrome, 42.1% (8/19) in patients of the stoppage of the qi of the bowels syndrome, 19.1% (13/68) in patients of toxic heat syndrome and 16.7% (2/12) in patients of blood stasis syndrome, the differences also being statistically significant (all P < 0.001). The scores of SOFA in septic shock group [7.0 (5.0, 10.0)] and acute deficiency syndrome group [6.0 (4.0, 9.0)] were significantly higher compared with those in sepsis group [3.0 (2.0, 4.0)] and other syndrome types patients [toxic heat syndrome 3.0 (2.0, 4.0), the stoppage of the qi of the bowels syndrome 4.0 (2.0, 6.0) and blood stasis syndrome 4.5 (3.0, 5.0)], the differences being statistically significant (all P < 0.001). Conclusions The distribution of TCM syndromes of sepsis is related to the severity degree of sepsis, in TCM dialectical typing of sepsis, from toxic heat syndrome developing into the stoppage of the qi of the bowels syndrome, and from blood stasis syndrome to acute deficiency syndrome, the SOFA score and lactic acid level were gradually increased as the disease condition was continuously aggravating, so the SOFA score and lactic acid could be used as the reference indicators for the severity degree of sepsis; in septic patients with different TCM syndromes, the rates of qSOFA ≥ 2 were different, and the qSOFA score combined with patient's TCM syndrome can enhance the early diagnosis of sepsis.