The Clinical Study Of Tonifying Qi And Warming Yang To Nourish Kidney Method Associated With CRRT Treatment On Acute Kidney Injury In Sepsis

Objective:To explore the curative effect of yiqiwenyangbushen method combined with continuous renal replacement therapy(CRRT) for sepsis patients with acute kidney injury.Method:Sixty-seven patients conformed to the diagnostic criteria of both sepsis and acute kidney injury in Intensive Care Unit(ICU) of Jiangsu Provincial Hospital of Traditional Chinese Medicine from April 2014 to January 2015 were enrolled. Of all the sixty-seven patients, twenty one refused to be dealed with CRRT, which belonged to non CRRT group, and were randomly divided into two subgroups named conventional treatment group and Chinese herbs treatment group. Ten patiens in the conventional treatment group received conventional therapy only, while another eleven patients in the Chinese herbs treatment group received yiqiwenyangbushen decoction on the biasis of routine treatment. Other forty-six patients agreed to accept CRRT, which belonged to CRRT group, and were randomly divided into two subgroups named CRRT group and CRRT combined with Chinese herbs treatment group. Twenty-three patients in the CRRT group received CRRT on the biasis of routine treatment, while another twenty-three patients in the CRRT combined with Chinese herbs treatment group received both CRRT and yiqiwenyangbushen decoction on the biasis of routine treatment. Dection of serum interleukin-6(IL-6), interleukin-10(IL-10), tumor necrosis factor alpha(TNF-a), sequential organ failure score (SOFA), oxygenation index (01), mean arterial pressure (MAP), and serum creatinine(Scr) were used to evaluate the curative effect of yiqiwenyangbushen decoction combined with CRRT for sepsis patients with acute kidney injury.Results:1. IL-6:No significant difference was found of serum IL-6 levels in the four groups before treatment(P>0.05). Serum level of IL-6 in each group declined more or less both 3 and 7days after treatment, which was most obvious in CRRT and CRRT+Chinese herbs group(P<0.05). Serum levels of IL-6 in CRRT+Chinese herbs group decreased significantly 7days after treatment (P<0.05)2. IL-10:No significant difference was found of serum IL-10 levels in the four groups before treatment(P>0.05). Serum level of IL-10 in each group was of no significant statistical difference 3days after treatment(P>0.05). But after 7days, Serum levels of IL-10 for patients in CRRT+Chinese herbs group increased significantly (P<0.05).3. TNF-α:No significant difference was found of serum TNF-a levels in the four groups before treatment(P>0.05). Serum level of TNF-ain each group declined more or less both 3and 7 days after treatment, which was most obvious in CRRT and CRRT+Chinese herbs group(P<0.05). Serum levels of TN F-a in CRRT+Chinese herbs group decreased significantly 7days hours after treatment (P<0.05)4.OI:No significant difference was found of OI for patients in the four groups before treatment(P>0.05). The patients’OI in each group increased significantly compared with prior treatment(P<0.05), and the OI level in CRRT+Chinese herbs group at 7days after treatment had a greater rise than which at 3days(P<0.05).5. MAP:No significant difference was found of MAP for patients in the four groups before treatment(P>0.05). Only in the CRRT+Chinese herbs group, patients’MAP increased significantly 3days after treatment (P<0.05), while after 7days, the patients’MAP in each group increased significantly compared with prior treatment(P<0.05).6. Scr:No significant difference was found of Scr for patients in the four groups before treatment(P>0.05).Both in the CRRT and CRRT+Chinese herbs group, patients’Scr declined significantly 3days after treatment (P<0.05).While after 7days, patients’Scr in each group all declined significantly compared with prior treatment (P<0.05).7. Cys-C:Four groups of serum Cys-C levels before treatment were not statistically different (P> 0.05). After treatment 3days, each group serum Cys-C levels were dropped to varying degrees, but no significant difference (P> 0.05), while in the 7days, Both in the CRRT and CRRT+Chinese herbs group, patients’Cys C levels was significantly lower (P<0.05), but compared with the 3days after treatment, no significant difference (P> 0.05)8. SOFA:No significant difference was found of SOFA scores for patients in the four groups before treatment(P>0.05). Both in the CRRT and CRRT+Chinese herbs group, patients’SOFA scores declined significantly 7days after treatment (P<0.05). While after 7 days, patients’SOFA score in each group all declined significantly compared with prior treatment (P<0.05)9. Mortality risk:It shows that with the use of CRRT, the prognosis of sepsis patients with acute kidney injury improved significantly by COX regression analysis. The mortality risk of patients receiving CRRT decreased 12%,5%,10%,and 3% respectively at their 3rd,7th,14th,30th day after entering ICU. Statistic differences were found on the results of the 3rd and 14th day (P<0.05)Conclusions:Yiqiwenyangbushen combined with CRRT could effectively remove inflammatory mediator, protect organ function, especially could reduce renal impairment, which is help to the early recovery of renal function and improve patients prognosis and reduce mortality. Yiqiwenyangbushen combined with CRRT have curative effect for patients suffering from sepsis induced acute kidney injury.