Based On The Inflammatory Mediators In Alveolar Lavage Fluid, The Clinical Application Of Resuscitation Mixture In Patients With Moderate-severe ARDS

Research PurposeTo evaluate the clinical application of Chinese herbal resuscitation mixture in the comprehensive treatment of moderate-severe ARDS patients,and to explore the effectiveness and safety of Chinese herbal preparations in the clinical treatment of ARDS patients with severe ARDS from the changes of inflammatory mediators in the alveolar lavage fluid of ARDS patients,so as to improve the ideas and new evidence for the research and treatment of Chinese herbal medicine.Research MethodsA total of 60 patients with moderate to severe ARDS admitted to the ICU of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from December 2019 to December 2020 were selected.By randomized,double-blind controlled scheme,the research standard of patients into two groups,treatment group was given western medicine comprehensive treatment(2019 ICS guidelines: the management of acute respiratory distress syndrome)+ recovery agent 1,20 g nasogastric or oral q6 h x 7 days,the control group in western medicine combined treatment(2019 ICS guidelines: the management of acute respiratory distress syndrome)+ recovery agent 2,20 g oral/nasogastric q6 h x 7 days.The treatment course was 7 days.TNF-α,IL-6 and IL-10(flow fluorometry),oxygenation index,PEEP,mechanical ventilation time and APACHE Ⅱ were compared in the alveolar lavage fluid between 2 groups during the treatment process.The statistical software R(Version 3.6.3;R Core Team,2020).Statistical analysis was conducted to observe the differences in clinical efficacy and safety indicators between the control group and the treatment group.Results1.Levels of TNF-α,IL-6 and IL-10 in alveolar lavage fluid: Compared with before treatment,inflammatory factors(IL-6,IL-10 and TNF-α)in alveolar lavage fluid in 2 groups were significantly decreased after treatment(P<0.001);There were no significant differences in inflammatory factors in alveolar lavage fluid between the two groups on the first day of treatment(P>0.05).On day 7 of treatment,the factors of alveolar lavage fluid in treatment group were significantly lower than those in control group(P<0.001).2.Oxygenation index analysis: the OI of the two groups on the 3rd and 7th day after treatment was significantly improved compared with the 1st day(P< 0.001).Compared with the control group,OI of the Fusu agent group was significantly improved on the 7th day(P < 0.001).3.Peep analysis: the level of PEEP in the Fusu agent group showed a significant downward trend with the increase of intervention time(P < 0.001),and there was interaction effect between time and grouping(P = 0.002).The downward trend of PEEP in the two groups was different,but the downward trend of PEEP in the Fusu agent group was significantly higher than that in the control group,but there was no difference between the two groups.4.Mechanical ventilation time: compared with the control group,the mechanical ventilation time of Fusu agent group was significantly reduced(P < 0.001).5.Comparison of TCM symptom score: compared with the control group,the TCM symptom score of Fusu agent group was significantly lower on the 7th day(P <0.001).Compared with the 1st day of treatment,the TCM symptom score of the Fusu agent group on the 7th day was significantly lower(P < 0.001).6.Comparison of TCM efficacy evaluation: Trend test was used to compare the TCM efficacy evaluation.The efficacy of patients in the Fusu agent group tended to be cured and markedly effective;the efficacy of patients in the control group tended to be effective or ineffective,that is,the overall efficacy of patients in the resuscitation mixture group was significantly better than that in the control group(χ2= 5.474,P= 0.019).7.APACHE II score: Compared with the control group,there was no difference in the APACHE II score on the 1st day and the 3rd day in the Fusu agent group(P>0.05),but the APACHE II score in the Fusu agent group was significantly lower on the 7th day(P < 0.001).8.Adverse reactions and safety: No obvious adverse events occurred in the two groups,and there was no statistical difference(P> 0.05).ConclusionsChinese herbal resuscitating mixture combined with western medicine can effectively reduce the inflammatory mediators in the alveolar exudate of ARDS patients.They also improved oxygenation and PEEP,reduced mechanical ventilation duration.The treatment group was better than the control group in TCM symptom score and TCM curative effect evaluation.Microenvironment samples of injured lung tissue can be obtained through virtual navigation combined with rapid field evaluation technology,which improves the reliability of clinical sample collection and plays a positive role in the reliability of TCM clinical research.