The Study Of Warming Yang And Motivating Qi Therapy For The Treatment Of Severe Sepsis Induced Myocardial Dysfunction

ObjectiveSepsis is a life-threatening organ dysfunction caused by a host’s dysfunctional response to infection.Cardiovascular system plays an important role in the pathologic development of sepsis and septic shock,and about half of the patients with sepsis may combined with myocardial dysfunction,which is known as severe sepsis induced myocardial dysfunction(SIMD).Sepsis patients with SIMD usually have a poor prognosis and are more likely to have progressive hemodynamic disorders and cardiovascular incidences.Compared with patients without SIMD,the case fatality rate is increased by 50%,and early intervention may have a positive effect on the prognosis.Thus,a prospective double-blind randomized control study was executed to investigate the efficacy and safety of Warming Yang and Motivating Qi Therapy by administering Xinmailong(XML)injection on SIMD patients.MethodFrom September 2016 to January 2019,a total of 82 patients were enrolled in this study.Therapeutic methods including fluid resuscitation,anti-infection,application of vasoactive drugs,mechanical ventilation and continuous renal replacement therapy(CRRT)were administered under the guidance of the SSC 2012 international consensus for the treatment of severe sepsis and septic shock.In the treatment group,besides the normal western medicine treatments,XML injection was applied at a weight of 5mg/kg each time with intravenous infusion(added with 0.9%sodium chloride injection 200ml at a rate of 20-40 drops/min)twice a day,with a interval time of more than 6 hours,5 days is a full course of treatment.Major outcome measures were echocardiography indexes,myocardial injury markers(troponin,brain natriuretic peptide)and the incidence rate of SIMD before and after treatment.The secondary outcomes included hemodynamic indexes,tissue perfusion indexes,mortality rate,SOFA and APACHE Ⅱ scores.Statistical analysis were performed to explore potential significant differences.ResultsThis study recruited 82 patients,42 of the treatment group and 40 of the control group.After data analysis,age,height,gender,SOFA,APACHE II score and other indexes of patients from two groups were basically the same,with no significant difference between the two groups,which indicated a sound comparability of baseline.For the major and secondary outcomes of this study.There were no statistically significant differences found in the incidence rate of SIMD,indexes of echocardiography or mortality rates between two groups.However,compared to the control group,the SIMD improvement rate(P=0.045)was higher,usage of endotracheal intubation as well as CRRT were lower on in the treatment group(P=0.03,P=0.03).Furthermore,the procalcitonin of treatment group was significantly lower than control group(P<0.01),while the urine volume was relatively higher(P=0.04).According to the results of repetitive measurement and analysis of variance at each observation time point,an obvious downward trend of APACHEⅡ scores in the treatment group was captured.As for drug safety,no trends of liver,kidney damage or coagulation disturbance detected.Conclusion1.For SIMD patients,the application of Warming Yang and Motivating Qi Therapy by administering XML injection can significantly improve myocardial dysfunction,cardiac diastolic function and prognosis.2.Reduce the usage of intubation and CRRT.3.Reduce inflammatory respond by lowering procalcitonin level and increase urine volume effectively.4.There were no obvious liver and kidney injuries and coagulation related adverse events in the study,which suggests sound safety.