老年脓毒症及脓毒性休克患者中医证素分布及预后分析

Distribution and prognosis analysis of TCM syndromes elements in elderly patients with sepsis and septic shock

目的分析老年脓毒症及脓毒性休克患者中医证素分布规律及中医证素、脓毒症序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分Ⅱ(APACHEⅡ)与短期死亡预后的关系。方法回顾性分析2021年1月1日-2022年5月1日北京中医药大学东直门医院、北京中医药大学第三附属医院急诊科及ICU诊断并接受治疗的58例患者的临床资料,按疾病类型分为脓毒症组38例、脓毒性休克组20例,收集2组患者基本信息、中医证素,以及SOFA评分、APACHEⅡ评分;按生存状态分别统计2组患者入组28 d的存活与死亡状况。采用关联规则分析患者中医证素分布规律,Logistic回归分析中医证素、SOFA评分、APACHEⅡ评分与死亡预后的关系。结果脓毒症患者中医证素主要集中在阴虚、肺、痰、气虚、血瘀、热、阳虚,脓毒性休克患者中医证素主要集中在阴虚、肺、阳虚、气虚。多因素Logistic回归分析显示,脓毒症组中医证素肝[OR(95%CI)为0.080(0.011,0.578),P=0.012]、经络[OR(95%CI)为0.088(0.011,0.718),P=0.024]及SOFA评分[OR(95%CI)为0.524(0.310,0.886),P=0.016]、APACHEⅡ评分[OR(95%CI)为0.426(0.186,0.977),P=0.044]是患者死亡预后的独立影响因素;脓毒性休克组中医证素痰[OR(95%CI)为0.014(0.001,0.267),P=0.005]、经络[OR(95%CI)为0.041(0.003,0.618),P=0.021]、阳虚[OR(95%CI)为0.028(0.002,0.427),P=0.010]及SOFA评分[OR(95%CI)为0.543(0.310,0.950),P=0.032]、APACHEⅡ评分[OR(95%CI)为0.633(0.408,0.985),P=0.042]是患者死亡预后的独立影响因素。结论脓毒症患者中医证素以虚实夹杂为主,脓毒性休克患者以虚性证素为主;气虚、阴虚贯穿疾病发展始终;中医证素经络、高SOFA评分、高APACHEⅡ评分的老年脓毒症及脓毒性休克患者可能预后较差。

Objective To analyze the distribution pattern of TCM syndrome elements in elderly patients with sepsis and septic shock,as well as the relationship between TCM syndrome elements,Sepsis Sequential Organ Failure Score(SOFA),Acute Physiology and Chronic Health ScoreⅡ(APACHEⅡ),and short-term mortality prognosis.Methods A retrospective analysis was conducted on the clinical data of 58 patients treated in the Emergency Department and ICU of Dongzhimen Hospital of Beijing University of Chinese Medicine and the Third Affiliated Hospital of Beijing University of Chinese Medicine from January 1,2021,to May 1,2022.The patients were divided into a sepsis group of 38 cases and a septic shock group of 20 cases based on disease type.Basic information,TCM syndromes,SOFA score,and APACHEⅡscore of the two groups were collected.The survival and death statuses of the two groups within 28 days of admission were separately analyzed.Association rule analysis was used to investigate the distribution pattern of TCM syndromes in patients,and logistic regression analysis was performed to explore the relationship between TCM syndromes,SOFA score,APACHEⅡscore,and death prognosis.Results In the sepsis group,the main TCM syndromes included yin deficiency,lung,phlegm,qi deficiency,blood stasis,heat,and yang deficiency;while in the septic shock group,the main TCM syndromes were yin deficiency,lung,yang deficiency,and qi deficiency.Multifactor logistic regression analysis showed that in the sepsis group,liver syndromes[OR(95%CI)=0.080(0.011,0.578),P=0.012],meridians and collaterals[OR(95%CI)=0.088(0.011,0.718),P=0.024],SOFA score[OR(95%CI)=0.524(0.310,0.886),P=0.016],and APACHEⅡscore[OR(95%CI)=0.426(0.186,0.977),P=0.044]were independent influencing factors for patient mortality prognosis.In the septic shock group,phlegm[OR(95%CI)=0.014(0.001,0.267),P=0.005],meridians and collaterals[OR(95%CI)=0.041(0.003,0.618),P=0.021],yang deficiency[OR(95%CI)=0.028(0.002,0.427),P=0.010],SOFA score[OR(95%CI)=0.543(0.310,0.950),P=0.032],and APACHEⅡscore[OR(95%CI)=0.633(0.408,0.985),P=0.042]were independent influencing factors for patient mortality prognosis.Conclusions The sepsis group mainly exhibits a mixture of deficiency and excess,while the septic shock group predominantly shows deficiency.Qi deficiency and yin deficiency are consistent throughout the disease progression.Meridians and collaterals,high SOFA score,and high APACHEⅡscore in elderly patients with sepsis and septic shock may indicate a poorer prognosis.