Clinical Observation On Influence To MODS By Treating Sepsis With Jiaweihuanglianjiedu Decoction

Purpose:MODS,spesis and systemic inflammatory response syndrome(SIRS) relations are close。Sepsis has been diagnosed as infection inaddition to the symptoms of systemic inflammatory response syndorme and immunological derangement。Sever sepsis,septic shock,MODS which develops by sepsis has the very high mortality rate is the present ICU main cause of death。Insufficient development in both medical diagnosis and treatment of sepsisi has led to continuous growth of mortality and morbidity in reported cases of sepsis for the past two decades。Although in recent years had the very big progress to sepsis and MODS understanding and the treatment research。But the MODS of Mortality rate had still not improved,the pathogenesis was not still clear。Many researchers devote in seeking cut the organ function dysfunction formation rate and the order of severity,prevents sepsis to the sepsis shock and MODS occurrence remedial measure.The cooperation of Chinese and Western medicine treated sepsis,MODS has demonstrated the unique superiority,now which has formed sepsis dialectical basically。The Chinese medicine treats sepsis and MODS to become the indispensable methodo The heat-clearing and detoxicating method is believed to be one of main preventing and curing methods of Spesis and MODS。Modern the massive pharmacology research indicated that the heat-clearing and detoxicating class medicine has antibacterial,anti-viral and the antiendotoxin function,the adjustment organism-immunity,the elimination free radical function and so on。This research selects Jiawei Huanglian Jiedu Decoction which Belongs the heat- clearing and detoxicating method to intervene sepsis,prevents it to develop MODS,and carries on the appraisal to its curative effect。This research adopts Jiawei Huanglian Jiedu Decoction to treate Sepsis,at the same time treats the polymorphonuclear(PMN) percentage,WBC,oxygenation index,the blood lactic acid,CRP,Glasgow Coma Scale(GCS) statistics around to the patient; Examines and carries on the statistics to patient PCT;Statistics to two group of patients in hospital expense,the daily expense,in hospital time; Statistics the patient single internal organs dysfunction's order,the internal organs dysfunction number and correspond APACHEⅡscore,APACHEⅢscore,SOFA score and Mortality rate;Around using APACHEⅡscore,APACHEⅢscore,SOFA score grading to treats the organ function to carry on the appraisal;The last to observe patient initial period performance in sepsis with different traditional Chinese medicine(TCM) syndormes。Methods:The clinical observation adds the Jiawei Huanglianjiedu Decoction to treat spesis to the MODS prevention function。32 patients were involved in this study who met the criteria of spsis in ICU of Guangzhou pafractionate university of TCM form May,2008 to March,2009,15 patients in treatment group were treated with western medicine combined Jiawei Huanglian Jiedu Decoction,17patients in controlled group were treated with western medicine alone。Around recording the patient's PCT value in hospitalized 24h or afther the diagnosis,carries on the contrast to the treatment around the polymorphonuclear(PMN) percentage,WBC,oxygenation index,the blood lactic acid,CRP,Glasgow Coma Scale(GCS) statistics,the patient single internal organs dysfunction's order,the internal organs dysfunction number and in ICU time,in hospital expense,mortality rate etal。Patients'clinical situation and outcom were observed by APACHEⅡscore,APACHEⅢscore,SOFA score, to study the clinical curative effect of Jiawei Huanglian Jiedu Decoction。The application Chinese medicine theory carries on the differernt syndome-classification of TCM to the patient。Results:1,The patient disease incidence rate Which more than 65 years old is high,accounts for the total number of people 50%,the mortality rate is so high which is 56.25%。2,32 patients were involved in this study,the sputum cultivation positive has 21 instances(65.63%),hemoculture postive 8 instances(25%), drainage fluid or urine culture positive has 7 instances(21.88%),cultivate negative has 7 instances(21.88%)。By infection of respiratory system primarily,next for digesting system infection(intra-abdorainal infection),uninary system infection,skin infection etal。3.This research demonstrated that the sensitivity(masculine gender rate) is 81.25%when diagnoses PCT＞2ng/ml,the specificity(false positive rate) is 90%,has the significance difference.4.Oxygenation index,the blood lactic acid,CRP,Glasgow Coma Scale (GCS) statistics significant difference between post-pretherapy of two groups(P＜0.05)。The time in ICU of TCM with Western medicine groupe is less than Western medicine group,expense of Every day and all in ICU is reductiono Mortality rate of TCM with Western medicine groupe is 20%,and Western medicine group is 52.94%,mortality rate of Western medicine group is higher than TCM with Western medicine groupe obviously.5.The order of Spesis patient internal organs dysfunction from high to low is respiration,gastro-intestines,brainn,coagulation,kidney,cardiovascular,heart,metabolisnu,liver。While the organ dysfunction number of sepsis patient develop to MODS increases,mortality rate also rise, patients who has 2 organs dysfunction are 4 examples(14.81%),mortality rate is 25%,3 organs dysfunction are 6 examples(22.22%),mortality rate is 33.3%, 4 organs dysfunction are 6 examples(22.22%),mortality rate is 33.3%,5 organs dysfunction are 7 examples(25.93%),mortality rate is 37.5%,≥6 organs dysfunction are 4 examples(14.81%),mortality rate is 75%.While the organ dysfunction number of sepsis patients develop to MODS increases,APACHEⅡscore,APACHEⅢscore,SOFA score also elevates,so as to Mortality rate. APACHEⅡscore,APAHCEⅢscore,SOFA score of organs is significant difference between pretherapy and post-treatment of combination of TCM with western medicine grope,the score of TCM with Western medicine groupe is decrease obviously than Western medicine group after the treatment.6.In this reaserch,internal Surplus of toxin-heat syndrome are more than internal exuberance of toxin and blood syndrome,afther treatment, 18 patients of toxin-heat magnificent syndrome,this is 18 patients(100%) develop to MODS,dies 8 examples,mortality rate is 44.44%,14 toxin-blood stasis stagnancy syndrome,this is 10 patients(71.43%) develop to MODS, dies 4 examples,mortality rate is 28.57%.Conclusion 1.≥65 year-old Spesis patients accounts for the great proportion,its case fatality rate is also high。Obviously our country marched into the old age society,the old age patient easy to initiate each kind of infection to send sepsis,therefore should strengthen the prevention which the senior citizen infects,prevents and control sepsis's occurrence early。2.This research demonstration:sepsis hemoculture postive may be a negative。By infection of respiratory system Primarily,next for digesting system infection(intra-abdominal infection),uninary system infection,skin infection,this also with the TCM theory exogenous evil influences attack,first violates the lung to be consistent。3.PCT may use in sepsis's diagnosis,the differential diagnosis,the judgment condition severity and the prognosis appraisalo The clinical appraisal has the high sensitivity and the specificity。Serum PCT early, may discover the risk of sepsis patient,has clinical values in judgment of the severity of infected patientS。4.Jiawei Huanglian Jiedu Decoction combined western medicine,namely has played the western medicine powerful bactericidal action,control infection rapidly,meanwhile uses the anti-poisonous detoxication of Jiawei Huanglian Jiedu Decoction which Belongs the heat-clearing and detoxicating method,Serves"toxin-bacterium treatment equally"purpose,eliminated the poison which the endotoxin causes,reduced patient's inflammatory reaction, improves every internal organs function and the patient organizes the perfuse,prevents organism various systems to have nonfunction。The Chinese and western drugs union may reduce the patient to apply the the time of antibiotic,reduces patient's expense in hospital,reduces the patient to live in the ICU time,reduces the ICU complication probability,cut the mortality rate.5.Condition severity and mortality rate of The MODS's patient with the organ number invovled to be positive correlatedo APACHEⅡscore,APACHEⅢscore and SOFA score are divided the value and the patient condition,the mortality rate present the correlational dependence,divides the value to be higher,the condition is more serious,mortality rate is higher。Jiawei Huanglian Jiedu Decoction combined western medicine to treat can improve sepsis and MODS patients internal organs function and severity degree,delays or blocks the organ function the further worsening,cuts patient's mortality rate,its overall curative effect surpasses the pure western medicine to treat.6.Sepsis morbidity diagnosis to sthenia syndrome by internal Surplus of toxin-heat syndrome and internal exuberance of toxin and blood syndrome primarily,the former is more than the latter。...