| BackgroundMODS relates to complicated and pathologic physiology process, difficultto prevent and cure, the mortality and medical cost remain unacceptablyhigh. Recently, the supportive care and etiological treatment make greatlyprogress, but the mortality rate, remains up to 30%～50%. How to reduce themorbidity and mortality of MODS, is a hot topic of domestic and internationalresearch .Gastrointestinal tract is thought to the starting motor of sepsisand MODS, and PMN activated, buildup to target tissue and released a greatdeal of toxicity is the main path leading to tissue damage and MODS.The Chinese medicine has no disease of MODS, following to use the WesternMedicine disease mostly, the similar Chinese medicine of its etiologicalfactor is "toxin pathogen". The heat-clearing and detoxicating method is oneof the main therapies of MODS. The modern pharmacology research expresses thatheat-clearing and detoxicating Chinese herbal medicine can anti- germs, virusand endotoxin, can also the anti- oxygen free radicals, mediators ofinflammation and tissue factors. Applied APACHEⅢto MODS clinical caseanalysis in order to guide in the clinic, at the same time, study theintervention of Huanglian-Jie-Du-Tang to MODSfrom the heart with the animalexperiment, to understand possible application value in the prevention andcure of MODS.Objective1. To investigate the influence factors of death of MODS through clinicalcase, evaluate objectively the cause of death and the occurrence rate of organs failure of MODS, providing the clinical prevention and cure strategy for theMODS.2. Inquiry into the effect and protection of organs function ofHuanglian-Jie-Du-Tang in the management of mediators of inflammation theHuanglian-Jie-Du-Tang, comprehending the physiopathogenic mechanism of MODS.Methods1. Through retrospective analysis of the 72 cases of MODS sufferers,applying the APACHEⅢto analyze the death factors, the prognosis ofdifferent types of syndrome of Chinese medicine and evaluate the function ofChinese medicine to MODS.2. Experiment with the belly cavity injects the mixed liquid ofzymosan-paraffin to manufacture the rat model of MODS. Divide group and layerrandomly, apply the physics, bio-chemical, the nuclear medicine and pathologyetc. method to evaluate multilayer of function of Huanglian-Jie-Du-Tang inthe management of MODS.3. The results of all data were shown in the form of (?)±SD and were dealedwith SPSS 13.0 programs of statistics, using standard t-test, leastsignificant differential method test, x~2, and correlation analysis.Results1. The clinical case retrospective analysis1.1. APACHEⅢof the survival group are higher than those of death group(p＜0.01);1.2. There is significant positive correlationamong the number of organfailure, length of stay in ICU, mortality and APACHEⅢ; APACHEⅢscore≥60, length of stay in ICU and the mortality increase significantly (P＜0.01);1.3. The mortality of Combined treatment of traditional Chinese medicineis higher than that of western medicine, but can decurtate length of stay inICU, and prolong survival time;1.4. The difference in mortality of different types of syndrome of Chinesemedicine is not statistically significant.1.5. The length of stay in ICU of heart failure patients is longer thanthat of no heart failure, but difference in mortality of them is notstatistically significant.2. The animal of MODS experiment research 2.1. Serum IL-6 measurement value of the Huanglian-Jie-Du-Tang intervenedgroup ascends slightly or slowly on different time stages. There is adifference compared to the model group (p＜0.05), but slightly higher thancontrol group.2.2. Heart rate measurement value of the Huanglian-Jie-Du-Tang intervenedgroup ascends slightly or slowly on different time stages. Compared to themodel group, a difference can be found (p＜0.05), but more quick than controlgroup.2.3. Heart MPO measurement value of the Huanglian-Jie-Du-Tang intervenedgroup ascends slightly or slowly on different time stages. Compared to themodel group, we find a difference (p＜0.05), but higher than control group.2.4. Compared with model group, the histopathology inHuanglian-Jie-Du-Tang intervened group is unchanged essentially.Conclusion1.1. APACHEⅢand number of organ-failure are important factorsaffecting the death of MODS patients.1.2. APACHEⅢis well to evaluate severity of disease in MODS patient,but not to predict mortality.1.3. The traditional Chinese medicine can postpone the course progressionof MODS.1. 4. The different types of syndrome of Chinese medicine have no predictionto prognosis.1.5. Heart failure is an important prognostic factor of MODS.2.1. The rat model of MODS show that gastrointestinal tract is thoughtto the starting motor of sepsis and MODS, and the activation of PMN, buildupto target tissue and released a great deal of toxicity main path lead to tissuedamage and developing to MODS.2.2. The experiment shows that pathogenesis of MODS is similar to Chinesemedicine of "toxin pathogen" cause "organs failure".2.3. The experiment suggests that different-dosage Huanglian-Jie-Du-Tangregulate the PMN infiltrating in tissue, protect organ from damage; Butit might be poisonous to organs function administering high-dosageHuanglian-Jie-Du-Tang.2.4. There is the relativity of time-dosage-effect according to theexperimental result of different-dosage Huanglian-Jie-Du-Tang in the management of mediators of inflammation and Multiple Organ DysfunctionSyndrome induced by zymosan in rats. |
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