Double-blind Randomized Controlled Trials Of Integrated Traditional And Western Medicine Treatment For The Dynamic Changes Of Serum Strem-1, PCT And CRP In Patients Of Sepsis With Acute Lung Injury/acute Respiratory Distress Syndrome(ALI/ARDS)

objectives: In this experiment, the influence of integrative Chinese and westernmedicine on the sTREM-1and inflammatory mediator was explored through observingthe dynamic changes of the sTREM-1and inflammatory mediator level in the patientswith ALI/ARDS.Methods: Double-blind randomized controlled clinical research was adopted todivide the adult patients with ALI/ARDS received and cured by the ICU and ThirdDepartment of General Surgery from March2010to March2013into two groupsrandomly. The control group (24cases in the western medicine group) was givenconventional therapy and200ml placebo through enema, twice a day and lasting for14days, while the observation group (24cases in the integrative Chinese and westernmedicine group) was given200ml oral Chinese medicine, or injected into the stomachtube, or enema on the basis of the control group, twice a day and lasting for14days.The changes in the sTREM-1, PCT and CRP on the first, third, seventh and fourteenthday were observed after the treatment of the two groups, and those indicators were keptdown, including the general situation, primary cause, respiratory functional parameter,TCM syndrome score, APACHE II grade, accumulative number of visceral organ,duration of mechanical ventilation, ICU hospital stays, total hospital stays, ICU casefatality rate and curative effect judgment.Results:(1). Comparison in the inflammatory factors of the two groups: aftertreatment, the inflammation indicators of the two groups (sTREM-1, PCT and CRP) all decreased. On the first, third, seventh and fourteenth day, the sTREM-1level of thewestern medicine group and the integrative Chinese and western medicine group wasnotably higher than the normal control group (P<0.01). When the integrative Chineseand western medicine group was compared to the western medicine group, thedifference in the sTREM-1level on the14thday had statistical significance (P<0.05),and the falling range of the integrative Chinese and western medicine group was moreobvious than the western medicine group; the PCT level of both western medicinegroup and the integrative Chinese and western medicine group on the first and third daywas higher than that of the normal control group (P<0.01), and the distinctions in PCTbetween the western medicine group and the normal group had statistical significance(P<0.05). The PCT level of the western medicine group on the seventh day and theintegrative Chinese and western medicine group on the fourteenth day was similar to thenormal control group, and it was of no statistical significance (P>0.05); the CRP levelof the two groups on the first, third, seventh and fourteenth day had significantstatistical differences when compared to the normal control group (P<0.01); whencomparing the PCT and CRP level at the same time of the two groups, there was nostatistical significance in the difference (P>0.05). However, after comparing the PCTand CRP level at different time in the two groups, it was discovered that the integrativeChinese and western medicine treatment had a better capability in regulating the plasmaand inflammatory factor than the western medicine treatment.(2). Comparison in the respiratory functional indicators of the two groups: on the14thday, the difference in the oxygenation indicator between the integrative Chineseand western medicine group and the western medicine group had statistical significance(P<0.05), while the comparison on the first, third and seventh day had no statisticalsignificance (P>0.05). The integrative Chinese and western medicine group graduallyincreased and turned normal on the14thday, and the comparison difference of the samegroup on the first and fourteenth day had statistical significance (P<0.05), while thewestern medicine group increased at the initial stage of the treatment, and decreasedgradually in the middle and advanced stage, and the comparison difference of the samegroup on the first and fourteenth day had no statistical significance (P>0.05). Thedifference in the PH, PaO2and PaO2/FiO2of the patients in two groups had no statisticalsignificance (P>0.05).(3). Comparison in the prognostic indicators of the patients in two groups: with the passage of time, the TCM syndrome score, APACHEII grade, accumulative number ofvisceral organ all decreased. The comparison of the TCM syndrome score on thefourteenth day between the integrative Chinese and western medicine group andwestern medicine group had statistical significance (P<0.05), but on the first, third andseventh day, there was no statistical significance (P>0.05). The comparison of APACHEII grade and accumulative number of visceral organ at the same point had no statisticaldifference (P>0.05). Besides, the integrative Chinese and western medicine treatmenthad no advantages in shortening the mechanical ventilation time, ICU hospital stays andtotal hospital stays, and decreasing the ICU case fatality rate than the single westernmedicine treatment, and the comparative difference of the two groups had no statisticalsignificance (P>0.05).(4). Comparison in the overall curative effect of the two groups: there was nostatistical significance in the comparison of overall curative effect between the westernmedicine group and integrative Chinese and western medicine group (P>0.05), but theformer was better than the later, for it might result from the small number of samplesand individual differences of the patients. The significant efficiency comparisondifference of the two groups had statistical significance (P<0.05), but that of theintegrative Chinese and western medicine group was higher than the western medicinegroup.Conclusion: the effect of integrative Chinese and western medicine in treating theALI/ARDS is better than the regular western medicine. Integrative Chinese and westernmedicine can decrease the serum inflammatory factor level of the patients withALI/ARDS, improve the recovery of oxygenation index and perfect the TCM syndromescore much more swiftly and sensitively, suggesting that the integrative Chinese andwestern medicine treatment plays a role in immune-regulation, promoting the recoveryof respiratory function and alleviating the lung injury.