| Severe sepsis and septic shock are common causes to multiple organ dysfunction syndrome, with a mortality of 30%-50%, which place a large burden on health care systems. Acute adrenal corticosteroid insufficiency is common in sepsis patients but a subsequent syndrome which is neglected easily, and will increase the mortality remarkably when it happens, in modern medicine, the main treatment is corticosteroid therapy, however, the use of high-does corticosteroids induces the risk of secondary infection and gastro-intestinal bleeding, even without an obviously decreased mortality rate. There are usually the same syndromes between the hypothalamic-pituitary-adrenal axis failure and the "Kinney-Yang insufficiency" in Chinese medicine, in theory, it may improve the prognosis if it can improve the function of the HPA axis through the Chinese crude drug which supplies the Kinney-Yang. Expandedness of the investigation is to learn the effect of the warming Kinney-Yang, Kinney-Yang to the prognosis of acute adrenal corticosteroid insufficiency patients in severe sepsis and septic shock.ObjectiveThe research is that based on the international guidance for treatment of severe sepsis and septic shock in 2008 of the "Surviving Sepsis Campaign", treating the acute adrenal corticosteroid insufficiency patients in severe sepsis and septic shock with plus or minus of the Chinese crude drug Sini-tang, then observing its validity and the security, in order to explore a safe, effective and economic new method for the treatment of adrenal corticosteroid insufficiency in critically ill patients, and to provide the basic evidence for further clinical application and promotion.Method Randomized controlled trial was used,31 in-patients whit severs sepsis or septic shock were observed in ICU in Charity Hospital affiliated to Guangdong Provincial TCM Hospital from March 2009 to February 2009. According to randomized table, patients were divided into two groups,17 in the trial group treated with plus or minus of Sini-tang, and 14 in the control group treated with low-does corticosteroids. In this investigation, it is expected to monitor the mean arterial pressure(MAP), heart rate(HR), blood lactic acid (LAC) and APACHE-II, and compare the level of cortex which reflect adrenal endocrinology before and after the treatment. And the occurrence of adverse reactions was recorded.Result1. The trial group of 17 cases, non-shedding,3d reversion rate of shock was 70.6%,28d survival rate was 76.5%, and the mortality rate was 35.3%.14 cases are observed in the control group, with 28.6%3d reversion rate of shock, 28.6%28d survival rate and 78.6%mortality rate. The 3d reversion rate of shock and 28d survival rate of trial group was significantly higher than that in the control group, the mortality rate of the trial ground was lower than that in the control ground,and the difference was significant (P<0.01).2. The level of adrenal cortisol in the trial group 7 days after treatment were significantly higher than that before treatment (P<0.05), compared with the control group there is a significant difference (P<0.05). The level of MAP and Lac in the trial group after treatment were not significantly improved than that before treatment (P>0.05), the level of HR and APACHE-II score in the trial group after treatment were significantly improved than that before treatment(P<0.05), compared with the control group there is significant difference (P<0.05) in MAP and APACHE-II score, however, there is no significant difference(P>0.05) in HR and Lac between the two groups.3. The level of adrenal cortisol in the patients who survived 48 hours and 7 days after treatment were significantly higher than that before treatment (P <0.01), compared with the patients who died there is a significant difference (P<0.05), the rising level of cortisol in patients survived was significantly higher than that of the patients died after the ATCH stimulating test.4. No adverse reaction was occurred in the trial group.Conclusion 1. Through the investigation we could considered that the warming Kinney-Yang could be an effective therapeutics for critically ill patients with acute adrenal corticosteroid insufficiency2. The effect of warming Kinney-Yang may be associated with improvement in the function of the HPA axis, which is conducive to revere the shock.3. The warming Kinney-Yang therapeutic is effective and safe. So we could conclude that it can be used extensively as an effective therapeutics of acute adrenal corticosteroid insufficiency in critically ill patients. |
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