Observation Of Modified Liangge Decoction In The Treatment Of Sepsis Associated With Acute Lung Injury Or Acute Respiratory Distress Syndrome

Objective:sepsis with acute lung injury or acute respiratory distress syndrome (ALI/ARDS) is one of the acute and severe common incidences in ICU, which are usually caused by a variety of infections, trauma, major operation after bacterial endotoxin invades blood circulation, resulting in systemic inflammatory response and further damage alveolar epithelial cells and capillary endothelial cells causes diffuse lung interstitial and alveolar edema, leading to acute hypoxic respiratory insufficiency. The clinical manifestations of systemic inflammatory response syndrome with progressive hypoxemia and respiratory distress. The incidence of this disease is high, the incidence rate of sepsis is about 77.6% in China’s ICU patients, among which 25%-50% of ALI/ARDS occurred, moreover the mortality in patients with ARDS is about 60%-70%. It is currently accepted the pathogeny are the out-of-control inflammatory response and the result of the imbalance of immune. At present the main treatment of modern medicine is mainly to support each system and organ’s function of the primary disease, and is still a lack of effective treatment methods according to the pathogenesis, which did not decrease the mortality of this disease significantly. In recent years, the domestic scholars who combine traditional Chinese and Western medicine method have made some progress in prevention of ALI/ARDS, symbolizing the advantages of multi-way, multi-link and multi-target therapy of Traditional Chinese Medicine. There are physical experiment and pharmacological research, Liangge decoction can block the inflammatory response, inhibit the endotoxin and improve the microcirculation. The study is based on standard Western medicine treatment of sepsis with ALI/ARD combined with TCM syndrome differentiation, with treatment for patients with positive "Liangge decoction" prescription. By observing patients’general condition, the TCM syndrome, oxygen effect synthetic index, cell factors, for the clinical use of Liangge decoction in adjuvant treatment of sepsis sepsis ALI/ARDS provides theoretical foundation and research method.Methods:in this study, all patients are from traditional Chinese Medicine Hospital of Hebei province in 2012 January to 2013 August in Respiratory Department of internal medicine, ICU with septic acute lung injury and acute respiratory distress syndrome. According to the diagnostic criteria, inclusion criteria and exclusion criteria selected was 30 patients, and by following the principle of "randomized control" 30 patients were divided into modified Liangge decoction treatment group of 15 cases, control group of 15 cases. Before the treatment, the treatment group and the control group had no statistical difference in clinical data, the two groups of patients are given the same specification of the basic treatment of Western Medicine (including active treatment of sepsis, mechanical ventilation, other organ support therapy),on the basis of this, the treatment group were given "Liangge Decoction" concentrated fry juice 100ml per day divided into two doses using nasogastric or enema method in the morning and evening for 7 days. And observe the mortality, APACHE II score, TCM syndrome integral, oxygenation index, TNF-a, IL-1, and IL-6 levels in patients before and after the treatment. The data were analyzed statistically using SPSS 17.0, all data count data to mean+standard deviation (X±S), the mean were compared with t test; measurement data such as compared with the rate of χ test,P<0.05 had significant difference, P<0.01 has a very significant difference.Results:1 The oxygenation index levels increased significantly after treatment in the combination of traditional Chinese medicine than Western medicine group (P<0.05), however compared with the combination of traditional Chinese and Western medicine group, the oxygenation index increased more significantly than the control group (P<0.05);2 TCM syndrome integral were lower in the combination of traditional Chinese medicine groups after treatment (P<0.05); and the TCM syndrome integral is more significantly lower than that of the control group (P<0.05).3 After the treatment, APACHE Ⅱ score decreased significantly both in the combination of traditional Chinese medicine and Western medicine group after treatment, and there was significant difference in two groups of APACHE Ⅱ score (P<0.05), showing that APACHE Ⅱ score in the test of traditional Chinese and Western medicine group decreased more the obviously than western medicine group.4 treatment, TNF-a levels of Chinese traditional group than Western medicine group (P<0.05); there was also significant difference of TNF-a (P<0.05) before and after the treatment, showing that the level of TNF-a decreased more obviously before and after the treatment of traditional Chinese and Western medicine.5 After the treatment, Chinese traditional group of IL-1 levels were not lower than Western medicine group (P>0.05); there was significant difference of IL-1 (P<0.05)before and after treatment, showing that the level of IL-1 decreased more obviously before and after the treatment of traditional Chinese and Western medicine group.6 After the treatment, Chinese traditional group of IL-6 levels were significantly lower than Western medicine group (P<0.01); there was significant difference of IL-6 (P<0.01)before and after treatment, showing that the level of IL-6 decreased more obviously before and after the treatment of traditional Chinese and Western medicine group.7 The mortality rate in 7th day in Chinese and Western medicine group is the same with the control group, thus there is no statistical significance (P> 0.05);Conclusions:1 compared with the fundamental pure western medicine treatment, combined with Liangge Decoction can obviously reduce sepsis ALI/ARDS patients pro-inflammatory cytokines, inflammatory reaction, so as to reduce the degree of lung injury and improve the patients’oxygenation index level.2 compared with pure western medicine treatment, combined with Liangge Decoction treatment can significantly reduce sepsis in patients with ALI/ARDS APACHE Ⅱ score and improve the acute pathology, physiological dysfunction and alleviate the symptoms.