Qi Righting Stasis Law Clinical Studies Of Sepsis, Coagulation Disorders Affect

Sepsis,one of severe complications of trauma,infection,shock and major surgery of critically ill patients,is a leading cause of septic shock and multiple organ dysfunction syndrome(MODS).Due to sepsis,septic shock and their sequelae,the mortality of inpatients are significantly increased recently throughout the world.How to survive patients with sepsis becomes a worldwide problem.Recent researches of clinical and laboratory have indicated that severe sepsis is extremely associated with systemic inflammatory response syndrome (SIRS)and coagulopathy,and often results in death.Therefore,it is a novel therapeutic strategy for clinical studies to treat sepsis against coagulation dysfunctions.However,there are no satisfactory effects from exclusively western therapy.Especially on coagulation improvement,we are lack of definite evidence to prove the effect of therapy aside from Actived Protein C(APC).As the theory system on sepsis of TCM established,researches on the TCM intervening the onset and development of sepsis are gradually initiated.After summarizing the experience of treating sepsis by combining of TCM with western medicine for years,my supervisor Professor Liu Qingquan set the following points. The core pathogenesis of sepsis is deficiency of both Qi and Yin and Yin-exhausting depleting Yang.Since coagulation disorders mainly belong to syndrome of blood stasis,Qi-blood theory improves coagulopathy.It means that as to patients with sepsis coagulopathy,while taking effective anti-inflammatory therapy,we use Chinese medicine with the function of supplementing Qi and Fu Zheng, detoxicating and dispersing blood stasis to intervene,with the destination of improving coagulation,reversing sepsis,and raising the ratio of survival.OBJECTIVE:To provide a novel therapeutic strategy on septic coagulation disorders by observing the coagulation of patients with such disorders after using Chinese medicine with the function of supplementing Qi and Fu Zheng, detoxicating and dispersing blood stasis.METHODS:40 patients with septic coagulation disorders meet the inclusive criteria admitted to ICU,DongZhiMen Hospital from 2005 Sep.to 2008 Mar.were randomly divided into two groups,group using exclusive ShenMai Injection(SM) and group using XueBiJing combining with ShenMai Injection(XBJ+SM).Test PT, APTT,TT,FIB,D-D,PLT,and record the data before therapy and on the 1^st,3^rd, 5^th,7^thday after therapy,focus on the dynamic changes of these items,evaluate patients with Marshall Score and APACHEⅡ,so as to learn the therapeutic effect of Chinese medicine in improving organ functions especially on coagulation disorders.Besides,record the result of patients after 28 days' therapy, divided them into two groups according to their prognosis,group of death and group of improving,to make sure the reference between the therapy by TCM and prognosis,which is supplementing Qi and Fu Zheng,detoxicatingand dispersing blood stasis.RESULT:1.In Group SM APTT and Marshall are significantly improved (P＜0.05)compared with pro to post therapy.And APACHEⅡis extremely lower after therapy(P＜0.01).2.In Group XBI+SM,PLT and TT are significant changed compared with pro to post therapy(P＜0.05).The level of PLT increased,the level of TT declined.To the level of APTT,PT,INR and Marshall,APACHEⅡ,they all have the extremely improved(P＜0.01),shorter than before.3.Compared with Group SM to Group XBJ+SM,except PLT and D-D,no significant different between two groups (P＞0.05),Come to the mean,PLT is higher in Group SM,D-D is lower in Group XBJ+SM,before the therapy.But after therapy,there are no differents on pathogenetic condition and coagulation function between two groups(P＞0.05),also include prognosis.This also can be regarded that Group XBJ+SM is more effective than Group SM on the aspect of PLT,D-D after therapy(P＜0.05).CONCLUSION:According to Qi-blood theory in TCM,as to patients with septic coagulation disorders,by using Chinese medicine with the function of either exclusive supplementing Qi,or combining it with detoxicating and dispersing blood stasis,the coagulation disorders and pathogenetic condition can be partly improved,so as to the prognosis.On the other side,we find that better effect can be achieved by using supplementing Qi and Fu Zheng,detoxicating and dispersing blood stasis at one time.The result provides an evidence for the therapy to patients with septic coagulation disorders of combining of TCM with western medicine.The thesis includes two parts.The first part is literature reviews,which consist of two parts.One summarizes the pathogenesis of sepsis from both Chinese and Western medicine aspect,the other summarizes the progress of therapy to coagulation disorders by Chinese and Western medicine.The second part is clinical research,studies on the inference of Chinese medicine with the function of supplementing Qi and Fu Zheng,detoxicating and dispersing blood stasis to patients with septic coagulation disorders.