脓毒症中医证型与RFcsa及28d生存率的回顾性队列研究

Relationship between TCM Syndromes and RFcsa and 28d Survival Rates with Sepsis:A Retrospective Cohort Study

目的探讨不同中医证型的脓毒症患者与急性骨骼肌肌肉萎缩进程及临床预后的相关性。方法采用回顾性队列研究方法,选择2017年10月—2019年5月入医院重症医学科(ICU)的符合纳排标准的61例脓毒症患者作为研究对象。中医证候分型以在入住ICU后的首个24 h内的电子病历系统及重症辅诊系统中可获取的证素来评定,遵循《中国严重脓毒症/脓毒性休克治疗》(2014)指南分型为标准划分为:急性虚证(34例)、毒热证(15例)、血瘀证(12例)、腑气不通证(0例);比较不同证型之间股直肌横截面积(RFcsa)变化率、ICU停留时间(LOS)、28 d功能独立性评分量表(FIM)中的运动功能评分的关系以及28 d生存率之间的差异。结果在校正混杂因素(年龄、性别、BMI、感染部位、有创通气时长、简化急性生理评分(SAPS)后,血瘀证脓毒症患者与急性虚证组相比,RFcsa变化率为:-14%(95%CI:-27%~-1%,P<0.05)。在校正混杂因素(年龄、性别、BMI、感染部位、有创通气时长、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分)后,中医证型为血瘀证的脓毒症患者与急性虚证组相比,RFcsa变化率为:-14%(95%CI:-26%~-1%,P<0.05)。使用Kaplan-Meier法绘制生存曲线,Log-rank检验进行组间生存率的比较,P=0.15,脓毒症患者不同证型28 d生存率差异无统计学意义。校正混杂因素后,不同证型的ICU停留时间及FIM运动功能评分差异无统计学意义。结论在回顾性队列的入住重症监护室的脓毒症患者中,血瘀证表现者的肌肉损耗进程较急性虚证者更为迅速;而不同中医证型的脓毒症患者之间,其ICU停留时间、28 d生存率及FIM的运动功能评分之间暂未发现差异有统计学意义。

Objective To investigate the correlation among different TCM syndromes and acute muscular wasting and clinical prognosis of septic patients.Methods A retrospective cohort was conducted.The data of 61 sepsis patients in the ICU of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2017 to May 2019 was collected.According to Guidelines for the Treatment of Severe Sepsis or Septic Shock in China(2014),the patients were divided into acute-deficiency syndrome(n=34),toxic-heat syndrome(n=15),blood-stasis syndrome(n=12)and Fu-organs Qi obstruction syndrome(n=0)when admitted to ICU.The cross-sectional area of Rectus femoris(RFcsa),length of stay(LOS)in ICU,28 d survival rates and the motor function scores in Functional Independence Rating Scale(FIM)among different TCM syndromes were compared.Results After correcting the confounding factors[including age,sex,BMI,site of infection,duration of invasive ventilation,simplified acute physiology score(SAPS)],the change rate of RFcsa in patients with blood-stasis syndrome was 14%,lower than that in patients with acute-deficiency syndrome group(95%CI:-27%~-1%,P<0.05).After correcting the confounding factors(including age,sex,BMI,site of infection,duration of invasive ventilation,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,the change rate of RFcsa in patients with blood-stasis syndrome was 14%,lower than that in patients with acute-deficiency syndrome(95%CI:-26%~-1%,P<0.05).Survival curves were plotted using the Kaplan-Meier method,and the log-rank test was used to compare the survival rates among different syndromes(P=0.15).There was no statistical significance in 28 d survival rates among different syndromes in patients with sepsis.After adjusting the confounding factors,there was no statistical significance in length of staying in ICU or FIM motor function scores among different syndromes.Conclusion In sepsis patients admitted to the ICU,muscle wasting in the blood-stasis syndrome group might be more rapid than that in acute-deficiency syndrome group.There were no significant differences in length of staying in ICU,28 d survival rates,and 28 d the motor function scores in FIM among sepsis patients with different TCM syndromes.