Relationship Between Excessive Inflammatory Response And Hemodynamic Parameters In Sepsis Or Septic Shock And The Role Of Xuebijing Injection

Objective:1. To investigate the relationship between the biomark of inflammatory response---WBC, N%, C-reactive protein, procalcitonin and cardiac preload, cardiac afterload, vascular permeability, tissue perfusion, heart function.2. To investigate wether Xuebi jing injections can reduce inflammation the leval of WBC, N%, C-reactive protein, procalcitonin or not, thereby improving cardiac preload, cardiac afterload, vascular permeability, tissue perfusion, cardiac function.1. A prospective analysis(2013.5-2013.13Guangdong Provincial Hospital of TCM ICU) included66patients with sepsis,15cases of them accepted PiCCO monitoring. They are divided into death and survival groups according to the living conditions of28d, Two groups of patients’WBC, N%, C-reactive protein, procalcitonin levels was recorded, as well as MAP, CVP, ITBV, GEDV, SVV, SVRI, EVLW, PVPI, ScvO2, P (va) C02, O2ER, LAC, and the amount of norepinephrine, then analysis the correlation of them.2. There are66patients with sepsis, and15cases of them accepted PiCCO monitoring.(2) PiCCO monitoring was used to measure the cardiac output (The average of three times) of the sepsis patients.(3) the hemodynamic data in24h,48h,5d was recorded, Two groups of patients’WBC, N%, C-reactive protein, procalcitonin levels was also recorded, as well as the dosage of norepinephrine in Oh,4h,12h,24h,48h,72h,5d, then analysis the correlation of them.Results:1. The mortality rate of66cases of patients with sepsis was22.7%. The average APACHE Ⅱ score was17.1points, SPAS Ⅱ score41.1points, SOFA score7points, with MODS score5.6points. Lung infections accounted for71.2%Abdominal infections accounted for33.3%.blood-borne infections accounted for6.0%. skin and soft tissue infections accounted for7.5%. urinary tract infection accounted for6.0%. In the type of infection, compared with the control group, The percentage of lung infection in the Death group was larger than the control group, The percentage of blood-borne infections is the opposite. Death group’s APACHE Ⅱ score (23.5±6.5vs.15.2±5.3), SPAS Ⅱ score (53.1±13.1vs.37.6±10.4), SOFA score (10.2±3.5vs.6.1±3.8), MODS score (8.5±2.5vs.4.8±2.9) was significantly higher than control group, the difference was statistically significant. Death group’s Heart rate (116.1±16. lvs.97.9±19.0), respiratory (24.5±6.4vs.19.3±5.7) was also significantly higher than control group, the difference was statistically significant. Other vital signs of patients were no statistically significant differences. Multivariate logistic regression analysis showed that CVP is an independent risk factor for death28d. Correlation analysis showed that the level of white blood cell levels were positively correlated with the LAC, the linear regression equation Y=9.935+1.784X (X behalf of the WBC, Y behalf LAC). White blood cell levels were negatively correlated with LVEF, linear regression equation Y-73.77-1.122X (X behalf of WBC, Y behalf LVEF). Leukocytes and other hemodynamic had no correlation. C-reactive protein and hemodynamic had no correlation. PCT was negatively correlated with CVP (r=-0.278, P=0.029). PCT and other hemodynamic had no correlation.2. According block randomized controlled way.patients were randomly divided into Xuebijing group and control group.(1) After treatment, Xuebijing group’s WBC, C-reactive protein levels decreased, however the control group’s showed an upward trend.The two groups’had no significant difference, suggesting Xuebijing have a role in inhibiting the inflammatory response aspects.(2)the circulation resistance of two group had no statistical difference, Over time, the Xuebijing group showed a decreasing trend on the dosage of norepinephrine, The two groups’had no significant difference.(3) Before and after treatment, there is no statistically significant difference between the two groups in the level of EVLWI, PVPI.(4)After treatment, there is no statistically significant difference between the two groups in the level of ScvO2、LAC, the Xuebijing group decreased in large, but no statistical difference between the two groups.(5) the28d survival rate of two groups had difference (P=0.0073), the difference was statistically significant.(6) TCM Constitution classification and determination analysis, blood stasis constitution more likely to cause inflammation (t=3.095, P<0.05), Xuebijing injection used in patients with blood stasis is more valuable.(7) compared to the control group, Xuebijing group’s ICU stay, CRRT time, norepinephrine time, antibiotic use, hospital costs was less, but the difference had no significant difference.Conelusion:1.(1) Within a certain range, the white blood cell levels and LAC levels were positively correlated.the white blood cell levels and tissue perfusion levels were negatively correlated.(2) Determine the time of hemodynamic changes is very difficult, inflammatory reaction does not fully explain the reasons for hemodynamic changes, and look for biochemical markers to determine the hemodynamic change is urgent clinical problems.2.(1) Xuebijing28d injection can improve the survival rate in patients with sepsis.(2) Xuebijing injection can reduce the dose of norepinephrine and the time of using. It can not change the vascular permeability, tissue perfusion.(3) Blood stasis were more likely to cause inflammation. Using Xuebijing injection for treatment is more valuable.(4) Xuebijing injection therapy can improve prognosis but more CRTs are needed.