Analysis Of The Efficacy And TCM Syndrome Types Of Shenfu Injection In Patients With Sepsis At Different Stage

Objective:Sepsis and septic shock,as common critical illnesses in emergency departments and ICU,have long threatened human life and health.The clinical morbidity,mortality,and economic burden of disease in sepsis remain high.In traditional Chinese medicine,sepsis and septic shock are treated based on syndrome differentiation,and good effects are achieved in the aspects of comprehensive treatment,regulation of patients’ immunity,reduction of inflammatory response,and protection of organ function.Among them,Shenfu Injection(SFI)has been widely used in the treatment of clinical sepsis and septic shock,but its efficacy in patients with sepsis at different stages and the distribution of TCM syndromes in sepsis at different stages have not been discussed yet.This study explored the efficacy of SFI in sepsis patients at different stages and the TCM syndrome types,in order to provide more ideas and references for the clinical treatment of sepsis.Methods:Patients who were admitted to the emergency department and ICU of Dongzhimen Hospital of Beijing University of Chinese Medicine,the emergency department and ICU of Third Affiliated Hospital of Beijing University of Chinese Medicine,and the emergency department and ICU of Wangjing Hospital of Chinese Academy of Chinese Medical Sciences and diagnosed with sepsis or septic shock from January 2019 to January 2023 were included using the real-world research.The patients were divided into sepsis group and septic shock group according to the difference in Sepsis 3.0 diagnosis at the time of inclusion in the study.According to whether the above two groups were treated with conventional treatment combined with SFI,the patients were divided into conventional treatment group and Shenfu group again.The heart rate,mean arterial pressure(MAP),vasoactive drug use,infected site,white blood cell count(WBC),platelet count(PLT),C-reactive protein(CRP),blood serum creatinine(SCr),blood urea nitrogen(BUN),blood lactic acid(Lac),procalcitonin(PCT),sepsis-related organ failure assessment(SOFA),disseminated intravascular coagulation(DIC)score,and TCM syndrome(consciousness,skin temperature,skin color,tongue,and pulse)changes in the four groups before and after treatment were collected,and the survival conditions and ICU stay time during the 28 days were followed up.SPSS 20.0 software was used for statistical analysis of the differences of each index between groups and between the Shenfu groups before and after treatment.The P<0.05 indicated that the difference was statistically significant.Results:1.A total of 38 eligible sepsis patients were included in the present study,including 11 patients in the Shenfu group;A total of 42 patients were included in the septic shock group,including 24 in the Shenfu group.There was no statistical difference in age,gender,distribution of infected foci,use of vasoactive drugs and pre-treatment heart rate,MAP,WBC,PLT,CRP,SCr,BUN,Lac and SOFA scores between the sepsis patients and the septic shock patients in the group(P>0.05).Baseline characteristics within groups of patients with sepsis and septic shock were homogeneous including disease severity,prior to treatment.2.It has been found that the TCM syndrome types of sepsis patients are mainly divided into eight syndrome types,with empirical study as the main one,which mainly include:phlegm heat in the lung,phlegm and blood stasis syndrome,qi stagnation and blood stasis syndrome,etc.The TCM syndrome types of patients with septic shock are mainly divided into 10 syndrome types,with the deficiency syndrome as the main one,which mainly includes:qi and yin deficiency syndrome,lung and kidney qi deficiency syndrome,yin deficiency and yang deficiency syndrome,etc.The deficiency of both qi and yin runs through the development of sepsis.The TCM symptom scores of patients with sepsis and septic shock before and after SFI treatment were significantly decreased(P<0.01).3.MAP of patients with sepsis and septic shock increased compared with the conventional treatment group after application of SFI,while WBC,SCr and BUN decreased compared with the conventional treatment group.Heart rate of patients with septic shock decreased compared with the conventional treatment group after application of SFI(P<0.05).However,the heart rates of PLT of patients with sepsis and septic shock after application of SFI as well as those of patients with sepsis after application of SFI were not statistically different compared with the conventional treatment group(P>0.05).4.The improvement values of CRP,Lac and SOFA in sepsis and septic shock patients before and after SFI,and the improvement value of PCT in septic shock patients before and after SFI were higher than those in the conventional treatment group before and after treatment(P<0.05).However,there was no significant difference in PCT improvement values of sepsis patients before and after SFI treatment as compared with the conventional treatment group(P>0.05).In addition,there was no statistical correlation between SFI and dominant DIC in sepsis and septic shock(P>0.05).5.In this study,SOFA and DIC scores were both factors influencing the 28-day survival rate of patients with sepsis and septic shock.Whether or not SFI was used was associated with the 28-day survival rate of patients(P<0.05).After the patients who died in the hospital were excluded,the analysis showed that the patients with sepsis and septic shock treated with SFI had shorter ICU stay time than those in the conventional treatment group(P<0.05).Conclusion:The study found that the TCM symptoms of sepsis patients are mainly empirical,while those of septic shock patients are mainly deficiency syndrome.The deficiency of both qi and yin runs through the development of sepsis.Conventional therapy combined with SFI can improve hemodynamics by increasing MAP and stabilizing heart rate in patients with sepsis and septic shock.It can improve the inflammatory response of patients and inhibit the further expansion of inflammatory response by reducing WBC and CRP of patients with sepsis and septic shock and PCT of patients with septic shock.The renal function of patients can be improved by reducing SCr and BUN in patients with sepsis and septic shock.To reduce Lac in patients with sepsis and septic shock to improve tissue microcirculation in patients.Conventional therapy combined with SFI also reduced SOFA score in patients with sepsis and septic shock,improved patient symptoms,increased 28-day survival,and shortened ICU stay.In addition,we have also found that both SOFA and DIC scores are independent factors affecting the 28-day survival rate of patients with sepsis and septic shock.The clinical indications,application timing and corresponding TCM syndrome types of SFI require further in-depth research and discussion.