Clinical Study On Treatment Of Acute Lung Injury Caused By Sepsis By. Journal Of Traditional Chinese Medicine]

ObjectiveTo observe the clinical efficiency and safety of the BaoFei JieJiong Mixture in the treatment of Acute Lung Injury (ALI) induced by Sepsis through the methods of stochastic control. In order to find the function that it could be prevent the progression of the disease from protopathy to ARDS and MODS, reduce the case fatality rate,and to provide treatment recommendations for the major infectious diseases,such as SARS, Avian influenza, Ebola Hemorrhagic Fever.Methods60 patients were selected who diagnosed with ALI induced by Sepsis from ICU of the Department of respiration emergency department in the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, from 2013 February to 2015 February. All the patients were randomly divided into integrated traditional Chinese and Western medicine treatment group (Treatment group) and Western Medicine treatment group (Control group).The control group was given western medicine treatment in accordance with the guidelines of sepsis and ALI. The treatment group was the given the Baofei Jiejiong mixture on the basis of solution of the control group.60 ml mixture was given by anasogastric or oral every 6 hours. All the obvervational indexes would be evaluated in the fixed time points which was in the prior treatment,3rd and 7th day of starting therapy. Inflammatory reaction indexes such as blood routine, C reaction protein (CRP), Procalcitonin (PCT), Interleukin -8 (IL-8) and Tumor Necrosis Factor alpha (TNF- alpha).Organ dysfunction was assessed by acute physiology indexes:such as Blood Lactic Acid,Acute and Chronic Health score (APACHEII score),Systemic Infection Related Organ Failure score (SOFA score). Lung injury index was assessed by Oxygenation Index (PaO2/FiO2), Lung Injury Score (LIS score), Extravascular Lung Water Index (EVLW) and 7th day mortality, the incidence of ARDS, the incidence rate of MODS.Results1.Analysis of baseline:The baseline data such as gender, age, underlying diseases, infection, white blood cell count before treatment, neutrophil percentage, alanine aminotransferase, blood urea nitrogen, serum creatinine, prothrombin time was compared between two groups had no significant differences (P>0.05).2. Analysis of the efficacy index:(1) The overall effect and fatality rate in the 7th day after treatment:the total effective rate of treatment group was higher compared with control group, but the difference was not statistically significant (P>0.05); Fatality rate of the treatment group was lower compared with control group, but the difference was not statistically significant (P>0.05).(2) Comparison of symptom score and efficacy of TCM:there was a significant difference in the TCM symptom score between two groups evaluated on the 3rd,7th day(P<0.05),compared with the control group the treatment group was better. The efficacy of TCM in treatment group was better than control groups, there was significant difference between two groups (P<0.05).③ Comparison of inflammatory reaction index between two groups① There was no statistical significance between two groups in the abnormal rate of WBC counts measured before and after treatment for 3 days (P>0.05), but had a statistical significance on 7th day after treatment (P<0.05). Treatment group was superior to control group.②There was no statistical significance between two groups in the concentration of CRP measured before and after treatment for 3 days (P>0.05),but had a statistical significance on 7th day after treatment(P<0.05). Treatment group was superior to control group.③ There was no statistical significance between two groups in PCT measured before and after treatment for 3 days (P>0.05), but had a statistical significance on 7th day after treatment (P<0.01). Treatment group was superior to control group.④There was no statistical significance between two groups in the concentration of IL-8 and TNF-a before treatment (P> 0.05), but had a statistical significance on 3rd,7th day after treatment (P< 0.05). Treatment group was superior to control group.(4) Comparison of Organ dysfunction index between two groups.①There was no statistical significance between two groups in the concentration of blood lactic acid before and after treatment for 3,7 days (P>0.05).②APACHE score was compared between two groups before and after treatment for 3 days, the difference was not statistically significant (P>0.05),but on 7th day after treatment the difference was statistically significant (P<0.05), the treatment group was better than the control group.③ There was no statistical significance between two groups in SOFA score measured before and after treatment for 3 days (P>0.05), but had a statistical significance on 7th day after treatment (P<0.01). Treatment group was superior to control group.④There was a statistical significance in the incidence of MODS after treatment for 7 days between two groups (P<0.05). Treatment group was superior to control group.(5) Comparison of acute lung injury between two groups.①There was no statistical significance between two groups in the oxygenation index before treatment (P>0.05),but had a statistical significance on 3 and 7th day after treatment (P<0.05). Treatment group was superior to control group.②There was no statistical significance between two groups in the extravascular lung water measured before and after treatment for 3 days (P>0.05), but had a statistical significance on 7th day after treatment (P<0.05). Treatment group was superior to control group.③There was no statistical significance between two groups in the LIS score measured before and after treatment for 3,7 days (P>0.05).④Compared to the incidence of ARDS of two groups on 7th day after treament, the difference was statistically significant (P<0.05).Treatment group was superior to control group.⑤Compared to the cases of patients using invasive mechanical ventilation in course of the treatment, the difference was statistically significant (P< 0.05).Treatment group was superior to control group.3. Analysis of the safety index:In course of the treatment, adverse reactions was 17.24% in treatment group and 10.71% in control, symptoms relieved with no special treatment, the patients could adhere to treatment. There was no statistical significance between two groups in the adverse effects (P>0.05).Conclusions1. Compared with the pure western medicine treatment, the treatment integrated TCM and Western medicine could reduce the 7 day case fatality rate and improve the efficiency of patients with ALI induced by sepsis.2. Compared with the pure western medicine treatment, the treatment integrated TCM and Western medicine had the advantage of improving the clinical symptoms, indicators of inflammation, organ dysfunction index (blood lactic acid except), and indexes of lung injury (except LIS) in patients with sepsis induced by ALI integral.3. Compared with the pure western medicine treatment, the treatment integrated TCM and Western medicine could reduce incidence rate that patients with ALI induced sepsis developed into ARDS and MODS, and reduce the utilization rate of invasive mechanical ventilation.