The Clinical Observation Of Huang Lian Jie Du Decoction For Prevention And Treatment Of Disseminated Intravascular Coagulation On MODS Patients

ObjectiveClinical observation of the prevention and treatment of multiple organ dysfunction syndrome(MODS)in patients with disseminated intravascular coagulation(DIC)by modern medicine combined with Huanglian Jiedu Decoction,to explore its intrinsic mechanism,to analyze the function of coagulation、anticoagulation、fibrinolysis system Predict the change of disease in MODS patients.MethodsAccording to the inclusion criteria,60 patients with M0 DS were included in the Department of Intensive Care of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 1,2017 to March 1,2018.MODS subjects were grouped according to the randomized principle.60 patients were actively treated according to the MODS treatment principle.Among them,30 patients(hereinafter referred to as traditional Chinese medicine group)who were treated with Huanglian Jiedu Decoction were treated with Chinese and Western medicine,and they did not use Huanglian detoxification.The study group of Tang was a western medicine treatment group of 30 cases(hereinafter referred to as non-Chinese medicine group),and 30 cases of non-MODS patients were also included as a blank control group.Monitoring plasma prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen degradation products(FDP),D-dimer(D-Di)on days 3,5,and 7 after treatment),antithrombin activity III(AT III),platelet(PLT)counts and infection indices: WBC,CRP,PCT The MODS score,acute and chronic physical health scores(APACHE II),sequential organ failure scores(SOFA),and the Japanese Critical Care Association’s proposed standard score(JAAM)were used to perform statistical analysis on the collected data.Results1.There was no significant difference in the age,sex,APACHEII score,and coagulation index between the three groups before treatment(P>0.05),and they were comparable.2.The abnormal coagulation function was found in patients with MODS and non-MODS patients.The main manifestations were prolongation of PT,increase of FDP,increase of D-Di,decrease of AT III,and decrease of PLT,with statistical significance(P<0.05).Among them,the difference between D-Di is the largest,followed by FDP and PLT.3.After treatment,the prolongation of PT,increase of FDP,increase of D-Di,decrease of AT III,and decrease of PLT in the Chinese medicine group were significantly better than those in the non-Chinese medicine group(P<0.05).After treatment,the WBC,CRP,PCT and MODS scores,SOFA scores,and JAAM scores of the two groups were all improved.The Chinese medicine group had significantly better improvement than the non-Chinese medicine group(P<0.05).In the two groups of clinical outcomes,the mortality rate was 43.3%in the Chinese medicine group and 67.6% in the non-Chinese medicine group.There was a significant difference between the two groups(P<0.05).4.Person-related analysis of WBC,CRP,PCT inflammation index and blood coagulation related indicators showed that there was a correlation.Correlation analysis showed that: PLT,AT III were negatively correlated with WBC,CRP,PCT,and PT,APTT,FDP,D-Di were positively correlated with WBC,CRP,PCT.The most relevant ones are PLT and D-Di.The correlation analysis of PLT,PT,APTT,FDP,D-Di and AT III with Persons of MODS score,SOFA score and JAAM score showed that there was correlation(P<0.05).The correlation analysis showed that: PLT,AT III were negatively correlated with the MODS score,SOFA score,and JAAM score,among which the PLT correlation was the highest.PT,APTT,FDP,D-Di were positively correlated with MODS scores,MODS scores,and JAAM scores,among which FDP and D-Di had the highest correlation.5.The area under the curve of PLT,PT,APTT and FDP is >0.9,which has better prediction.The area under the curve is the largest PLT is 0.963,the value is 107 109 / L,when the PLT <107 109 / L,the accuracy of the diagnosis of MODS is higher,the sensitivity of the value of 0.932,the specificity is0.912,PT,FDP followed,AT III minimum.Among the inflammation indicators,the area under the CRP curve was the largest,being 0.872,and the WBC wasthe smallest.In the rating scale,the area under the JAAM curve was the largest,being 0.902.The score was 6.6 points.When the JAAM score was greater than6.6,the likelihood of occurrence of MODS increased.Conclusions1.Most of the patients with MODS had abnormal coagulation system,which was more likely to occur in patients with sepsis.2.Huanglian Jiedu Decoction combined with modern medical treatment of MODS patients can improve their coagulation function,of which the more obvious improvement is PLT,FDP and D-Di.And combined use of Huanglian Jiedu Decoction can improve the clinical outcome of patients with MODS.3.The application of Huanglian Jiedu Decoction can significantly improve the inflammatory index in patients with MODS.The underlying mechanism is that Huanglian Jiedu Decoction can inhibit the initial inflammatory response and reduce endothelial cell damage,thereby improving coagulation function and preventing and curing DIC in patients with MODS.4.The coagulation index PLT on the condition of MODS changes have a good predictive value,scoring items in the JAAM score on the condition of MODS changes have a good predictive value.