Evaluation Of The Efficacy Of Qingfei Tongfu Method In Treating Sepsis With Qi-excess Heat Syndrom

BackgroundSepsis is characterized by high morbidity and mortality,and its prevention and treatment has always been a difficult problem in the medical field.With the in-depth exploration of sepsis in the medical community,the definition,pathogenesis and therapies of sepsis have been gradually updated,but in the intensive care unit(ICU),it is still the main cause of death.As the "intestinal activated theory" and "lung activated theory" play an important role in the pathogenesis of sepsis,people try to inhibit the inflammatory response to truncate the injury of the extrapulmonary organs,and block the intestinal lymphatic system to truncate the intestinal bacterial translocation.A large number of clinical studies and experimental studies have verified the theory of Traditional Chinese Medicine(TCM)"interior and exterior relationship between the lung and large intestine".And the derived therapies to sepsis and its related diseases have obtained good clinic curative effect.However,how to cut off the progression of sepsis via TCM in the early stage has always been a difficult problem for clinical workers.Therefore,this study attempts to explore solutions to the issue based on clinical studies.ObjectiveThe paper relys on researching the therapeutic effect for the syndrome of Qifenshire in septic patients on the use of Qingfei Tongfu Method,aiming to provide a new idea for early interception of sepsis in the future.MethodsPlanning to observe the 30 patients with sepsis in the syndrome of Qifenshire which satisfy the inclusion criteria during the period from October 2016 to December 2018 in Dongzhimen Hospital,Beijing University of Chinese Medicine.Considering the loss rate of 20%,36 patients should be included.Divide them into intervention group and control group randomly,the control group(18 cases)for standardized western medicine treatment,the intervention group(18 cases)for standardized western medicine treatment combined with MaXingShiGan decoction and DaChaiHu decoction.Observe the two groups respectively and record their main efficacy indicators,such as temperature,infection indicators——white blood cells(WBC)count、neutrophil percentage(NE%)、c-reactive protein(CRP),the acute physiology and chronic health conditions(APACHE)Ⅱ score,TCM syndrome score.And the secondary efficacy indicators,such as respiratory rate,heart rate,sepsis related organ failure assessment(SOFA)score and assessment of individual organs[oxygenation index,blood platelet(PLT)count,total bilirubin(TBIL),Glasgow score,creatinine(Gr)],gastrointestinal function score,the mortality during the 28 days before the treatment and at the third,fifth,seventh,and tenth day in the process and then make statistical analysis.To evaluate the therapeutic effect for the syndrome of Qifenshire in septic patients on the use of Qingfei Tongfu Method.Results(1)Intergroup comparison:Compared with the control group,the intervention group’s temperature decreased more significantly on the 3rd,7th and 10th day(P<0.05);NE%decreased more significantly on the 5th day(P<0.05);CRP was significantly decreased on the 3rd,5th,7th and 10th day(P<0.05);APACHE Ⅱ score decreased more significantly on the 5th,7th day(P<0.05);Heart rate improved more significantly on the 3rd day(P<0.05).WBC count,TCM syndrome score,TCM syndrome efficacy,respiratory rate,oxygenation index,PLT count,TBIL,Glasgow score,Gr,SOFA score,gastrointestinal function score,the mortality during the 28 days were not statistically significant compared with the control group.The effective rate of TCM syndromes efficacy in the intervention group was 87%better than that in the control group which was 69%.(2)Comparison within the group:The temperature,the WBC count,NE%,CRP,APACHE Ⅱ score,TCM syndrome score,respiratory rate,heart rate,oxygenation index,the PLT count,TBIL,Glasgow score,Gr,SOFA score on the 3rd,5th,7th and 10th day showed satistical significant difference from that before the treatment(P<0.05).There was no satistical significant difference in gastrointestinal function score on the 3rd,5th,7th and 10th day compared with that before the treatment(P>0.05).In the trend of mean change,the temperature and respiratory rate of the intervention group gradually decreased,while the control group increased on the 7th compared with the 5th day.Conclusion(1)The main efficacy:The intervention group improved the temperature of the patients,which was more significant than the control group.In terms of infection indicators,the NE%of the intervention group was significantly lower than that of the control group on the 5th day;the CRP level of the intervention group showed satistical significant difference from that of the control group on the 3rd,5th,7th and 10th day;Indicating that Qingfei Tongfu Method has a certain role in reducing the inflammatory response of patients;NE%,CRP would be used as an indicator of early prognosis in sepsis,and CRP is more sensitive.In terms of APACHE Ⅱscore and TCM syndrome efficacy,compared with the control group,the APACHE Ⅱ score decreased significantly on the 5th and 7th day in the intervention group;There was no significant difference in TCM syndrome scores and efficacy between the two groups after treatment;In the intervention group,the effective rate after treatment was 87%higher than that of the control group which was 69%;It indicated that the intervention group had an advantage over the control group in improving the overall condition of the patient at an early stage.(2)The secondary efficacy indicators:The intervention group improved the heart rate of the patients,which was more significant than the control group.And in terms of improving respiratory rate,it was more stable than the control group.In terms of SOFA score and its assessment of various organs,the intervention group and the control group had similar efficacy in improving the function of individual organs,such as oxygenation function,liver function,awareness level and renal function,as well as the function of all organs.In terms of gastrointestinal function score and the mortality during the 28 days,the gastrointestinal function was improved in both the intervention group and the control group after treatment,but there was no significant difference whether intergroup comparison or comparison within the group;there was no significant difference in the mortality during the 28 days between the two groups;Considering that it was related to the small sample size of this study.