Clinical Observation Of Xuanfei Tiaochang Formula On Improving Capillary Leakage Index In Patient With Acute Respiratory Distress Syndrome Induced By Sepsis

BackgroundSepsis is the main cause of acute respiratory distress syndrome(ARDS),and the lung is often onset as the first damaged target organ in multiple organ dysfunction indexed by sepsis.Therefore,ARDS caused by sepsis is one of the common critical illnesses in ICU wards.Which is characterized by rapid onset,rapid progress,poor prognosis and high mortality and disability rate.The pathogenesis of sepsis ARDS is varied and complex,involving multiple system injuries.At present,Western medicine still focuses on the control of the primary disease and organ support treatment.There is no exact and effective method,so as the treatment strategies are still being updated.Xuanfei Tiaochang Formula is based on the concept of "mutual treatment of lung and intestine",and is derived from Xuanbai Chenqi Decoction.It has the effects of clearing away heat and detoxification,promoting lungs and setting asthma,clearing the fu-organs and purging turbidity,and has the functions of beneficial qi,strengthening the body,and strengthening the foundation.The main components such as rhubarb,astragalus and gypsum,have been proved to have unique advantages in controlling inflammation reaction,protecting vascular endothelial cells,alleviating capillary leakage and improving microcirculation stasis.Therefore,this paper explore the effect of Xuanfei Tiaochang Formula on ARDS patients with sepsis,and broaden a new idea for the prevention and treatment of ARDS patients with sepsis by combining traditional Chinese and Western medicine.ObjectiveTo observe the improvement of Xuanfei Tiaochang Formula on the capillary leakage index(CLI)of ARDS patients with sepsis,as well as indicators of respiratory function,inflammatory response,circulatory perfusion,illness score,the duration of mechanical ventilation,fatality rate,health economics,etc.It can provides a theoretical basis for the application of Xuanfei Tiaochang Formula in the treatment of sepsis ARDS.MethodsUsing a retrospective cohort study method,the ARDS patients with sepsis who were admitted to the Department of Intensive Care Unit,Fangcun Branch of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2016 to June 2020 were divided into exposed group and non-exposed group according to whether Xuanfei Tiaochang Formula was used.The exposed group was treated with Xuanfei Tiaochang Formula on the basis of conventional Western medicine treatment,while the non-exposed group was only treated with conventional Western medicine or combined with other traditional Chinese medicine treatment expected Xuanfei Tiaochang Formula on the basis of this treatment.The two groups were observed the changes of CPR,ALB,CLI,blood gas analysis,oxygenation index,respiratory rate,duration of mechanical ventilation,inflammatory response,circulatory perfusion,APACHEII score,SOFA score,Murray lung injury score and outcome indicators before and after treatment.Statistical analysis and comprehensive clinical evaluation were performed on the study results.Results1.A total of 264 ARDS patients with sepsis were included in this study,including 117 in the exposed group and 147 in the non-exposed group.2.Baseline situation:There was no significant difference in general conditions between the two groups(P>0.05);The distribution of infected lesions in the two groups was compared.The patients included in this study were mainly pulmonary infection(104 cases(88.9%)in the exposed group,117 cases(79.6%)in the non-exposed group),and there was no significant difference(P>0.05);The ARDS degree classification of the two groups of patients was compared.Both groups were classified as mild(48 cases(41.0%)in the exposed group,59 cases(40.1%)in the non-exposed group)and moderate(56 cases(47.9%)in the exposed group,80 patients(54.4%)in the non-exposure group)level,and the difference was not statistically significant(P>0.05);The basic vital signs,shock and MODS status,blood gas analysis,respiratory support method,inflammation index,circulatory perfusion index,APACHEⅡ score,SOFA score and Murray lung injury score were not statistically different between the two groups before treatment(P>0.05).3.Main efficacy index:(1)On the 5th day after treatment,CRP and CLI(CRP/ALB)in the two groups were significantly decreased compared with before(P<0.01);The ALB of the exposed group on the 5th day after treatment was not significantly different from that before treatment(P>0.05),while the ALB of the non-exposed group on the 5th day after treatment was decreased,with statistical significance(P<0.01);(2)The CRP and CLI of the exposed group on the 5th day after treatment were lower than those of the non-exposed group,and the difference was statistically significant(P<0.05);Compared with the ALB on the 5th day after treatment,the two groups had no significant difference(P>0.05);The difference in CLI of the exposed group before and after treatment was greater than that of the non-exposed group,and the difference in ALB was smaller than that of the non-exposed group,indicating that the improvement of CLI and ALB was better than that of the non-exposed group(P<0.05);CRP before and after treatment between the two groups Compared with the difference,there was no difference in the statistical results(P>0.05).3.Secondary efficacy index:(1)Respiratory function index:①The pH,PaO2,SaO2,oxygenation index OI(PaO2/FiO2)of the two groups on the 5th day after treatment were significantly higher than those before the treatment,with significant difference(P<0.01);The PaCO2 of the exposure group was higher on the 5th day after treatment,there was no statistical difference before treatment(P>0.05),PaCO2 of the non-exposure group increased on the 5th day after treatment,and the difference was statistically significant(P<0.01);There was no statistical difference in blood gas analysis index and difference between 2 groups on the 5th day after treatment(P>0.05);②The respiratory rate of the two groups of patients after treatment was significantly lower than that before treatment(P<0.01);The difference in respiratory rate before and after treatment was statistically different between the two groups(P<0.01);③The duration of non-invasive mechanical ventilation and total mechanical ventilation of the exposed group was lower than that of the non-exposed group(P<0.05),and the duration of invasive mechanical ventilation was longer than that of the non-exposed group(P<0.05).(2)Inflammation index:On the 5th day after treatment,the inflammatory indexes in both groups were significantly improved compared with those before treatment(P<0.01);There was no significant difference between the two groups of inflammation indexes and the difference on the 5th day after treatment(P>0.05).(3)Circulating perfusion index:There was no statistically significant difference between the two groups before and after treatment in LAC and MAP(P>0.05);There was no statistically significant difference in the lactate clearance rate,LAC,MAP and the difference between the two groups on the 5th day after treatment(P>0.05);There was no significant difference in the use of vasoactive drugs during the treatment period between the two groups(P>0.05).(4)Critical score index:5 days after treatment in both groups of APACHEII score,SOFA score,Murray lung injury score than before treatment significantly improved(P<0.01);There was no significant difference in the scores between the two groups before and after the index(P>0.05).(5)Mortality:There was no significant difference in ICU mortality and 28-day mortality between the two groups(P>0.05).ConclusionXuanfei Tiaochang Formula can improve the capillary leakage index of ARDS patients with sepsis,suggesting its protective effect on vascular endothelial function,and can reduce pulmonary edema to a certain extent;Improve respiratory function index and relieve respiratory distress symptoms;Shorten the duration of mechanical ventilation and promote the recovery of respiratory function,thereby reducing the occurrence of difficult withdrawal and ventilator-related complications;Reducing infection indicators and controlling systemic inflammation.It has practical value in clinical treatment.However,the effect of intensive score was not obvious in this study.Although the APACHEⅡ,SOFA and Murray lung injury score of the two groups after treatment were significantly improved,but there was no statistical difference between groups.The improvement of survival rate in this study is also not significant,which may be related to the small sample size.The included patients are mainly mild and moderate ARDS,which is related to the selective bias.Therefore,the sample size needs to be expanded in the future for further in-depth research.