Study On Effects Of Yiqi Tongfu Xiere Therapy On Sepsis-induced Acute Lung Injury

BackgroundALI (acute lung injury)/ARDS(acute respiratory distress syndrome) is non-cardiogenic, acute hypoxic respiratory failure causing by injury of both endothelial and epithelial cells, with subsequent aveolar flooding, which usually develops in response to amajor insult such as sepsis, shock, trauma, and burn, etc. Sepsis is the most frequent risk factor for the development of ALI/ARDS (as high as37%and even more). Sepsis-induced ALI has been reported to have a higher case fatality rate than other causes of ALI. Despite recent therapeutic advances, ALI/ARDS is still associated with high mortality rates.Professor Liu Weisheng has been engaged in medical care, medical teaching and medical research for for decades, accumulating rich experiences in treatments for critical pulmonary disease and tumour both in traditional Chinese medicine and Westren medicine. The present study summerize Academic ideas of Professor Liu Weisheng about critical pulmonary disease and tumour. Literature research of Sepsis-induced ALI/ARDS shows that few studies are about TCM syndromes. Studies about TCM treatments for Sepsis-induced ALI/ARDS show that TCM treatments may be beneficial. But most of them are Animal experimental studies focusing on pathological changes and regulation of pathogenesis factors. There is a lack of study about effect of TCM treatments on pathogenesis such as mortality, disability and28-day survival rate, etc. The present study summerizes TCM syndromes of sepsis-induced ALI patients. Based on Professor Liu Weisheng’s experiences on treating acute respiratory failure, carrying a prospective randomized controlled trial on Yiqi Tongfu Xiere Therapy treating Sepsis-induced ALI patients to observe the effects and the possible pathogenesis. Object ives1.To summarizes Professor Liu Weisheng’s academic ideas and treatment experiences on critical pulmonary diseases.2. To investigate the common elements of TCM syndromes of sepsis-induced ALI patients, summarize the characteristics of TCM syndromes of sepsis-induced ALI patients.3. To observe the effects of Yiqi Tongfu Xiere Therapy on Sepsis-induced Acute Lung Injury patients.Methods1. Summarized the common elements of TCM syndromes of sepsis and ALI/ARDS patients through literature. Subsequently using clinical cross-sectional survey research methods and69patients enrolled with sepsis-induced ALI. Among69cases,51cases were non-ARDS patients,18cases were ARDS patients;40cases were severe sepsis cases and29cases were septic MODS patients. To incorporate the basic TCM syndrome when investigating factors, including the basic deficiency:qi deficiency, blood deficiency, yin deficiency, yang deficiency, the basic excess class:phlegm, fiery, blood stasis, fluid-retention. Carried out statistical analysis of different groups, carried out correlation study on the basic elements of the TCM Syndrome and APACHE Ⅱ score.2. Using prospective randomized controlled clinical research methods, a total of51sepsis-induced ALI patients enrolled. Appling simple randomized method to divide into random groups,26cases in trial group and25cases in control group. Experimental group and Western treatment control group treated in accordance with international guidelines of sepsis, while the experimental group was treated with Yiqi Tongfu Xiere therapy at the same time, and compared the clinical efficacy of the two groups. Taking The hospital survival rate,28-day survival rate as the primary endpoint, taking respiratory function, cytokine levels, coagulation function and APACHE Ⅱ score as a secondary efficacy evaluation.Results1. Carried out investigation on the TCM syndromes of the69cases of sepsis-induced ALI/ARDS patients, the results found out that the pattern of deficiency-excess complex was the most common, accounting for81.2%,18.8%of pure excess, no patient was showed to be simple deficiency. In the basic elements of deficiency syndrome, qi deficiency was the most frequent (100%), followed by Yang Deficiency (39.1%), Yin deficiency syndrome (26.1%), blood deficiency (11.6%). In the basic elements of excess syndrome, the highest frequency of occurrence was phlegm (92.8%), followed by fiery (85.5%), blood stasis (58.0%), fluid-retention (13.0%). There is no significant difference in the constituent of the basic TCM syndromes between non-ARDS and ARDS patients. As compared with sever sepsis patients, yang deficiency syndrome increased in septic MODS patients which was statistically significant (P<0.05). APACHE Ⅱ score of elements of different syndromes were compared, results showed that the APACHE Ⅱ score was higher with patients which occurred yang deficiency than patients who had not occurred Yang Deficiency (P<0.05).2. From the prospective randomized controlled study,3patients of the trial group and2patients of the control group died within5days, data collection was incomplete, and to be removed, the loss rate of two groups was not statistically significant. A total of46cases eventually entered statistical analysis, of which23cases as experimental group,23cases as control group. The results failed to confirm that Yiqi Tongfu Xiere Therapy help to improve the mortality,28-day survival rate and length of hospitalization of sepsis-induced ALI patients. Compared with the control group, Significant improvement was detected in APACHE Ⅱ score, partial respiratory parameters (pH、SaO2on the second day of ventilation) in the trail group. In the inflammatory response, the study observed that Yiqi Tongfu Xiere Therapy help reduce the concentrations of serum CRP which may play a certain role to reduce systemic inflammatory response. However, compared with the control group, the trial group in the regulation of TNF-a, IL-6and IL-10has not showed a greater advantage. In the coagulation function, the study observed that Yiqi Tongfu Xiere Therapy help improve the coagulation function parameters of PT and APTT, which may play a certain role to improve coagulation function. The study observed that Yiqi Tongfu Xiere Therapy help reduce the concentrations of serum lactate, which may play a certain role to improve microcirculationConclusions 1. Professor Liu Weisheng pays much attention to the combination of syndrome differentiation and disease differentiation, advocates the intergration of chinese and western medicine, and his academic thought mainly embodies in intergral treatment of Pulmonary and the Large Intestine, conditioning the Stomach Qi, Supplementing qi and Strengthening the Body, intergration of chinese and western medicine to Chinese and western and rational drug using such five aspects.2. Sepsis-induced ALI patients are found to be categorized as a pattern of deficiency-excess complex. In clinical intervention, giving consideration to both "deficiency" and "reducing excess" is necessary. At the stage of MODS in sepsis, the incidence of Yang deficiency tended to increase and so attention should be paid to "support the Yang" treatment.3. Yiqi Tongfu Xiere therapy may play a certain role to reduce systemic inflammatory response, improve coagulation function, microcirculation and short-term respiratory function and overall condition.