Study On The Diagnosis And Treatment Of Sepsis In Chinese And Western Medicine

Sepsis is the body’s harmful systemic reaction to microbial infection. According to the condition of sepsis degree classification, it can be divided into sepsis, severe sepsis and septic shock. Severe sepsis refers to sepsis associated with organ dysfunction or low blood pressure and tissue perfusion. Septic shock is a status that the hypotension and tissue hypoperfusion still can’t be corrected after adequate fluid resuscitation, with organ dysfunction continuing. Though application of vasopressor can not have low blood pressure, it should also be regarded as septic shock.Sepsis mortality remains high, and it’s incidence increased year by year. In bacterial culture, recent reports show that gram-negative bacteria is more than gram-positive bacteria. Among different people, the incidence of sepsis is not the same.Clinically, bacterial drug resistance problem has become increasingly common. Bacterial sepsis is a leading cause of death ICU patients. Gram negative bacteria and gram positive bacteria trigger mechanism of sepsis is slightly different:gram-negative bacteria by endotoxin, gram-positive bacteria present antigen.The physiopathologic mechanism of sepsis is mainly for the pathogens causing unbalance of pro-inflammatory and anti-inflammatory responses, causing coagulopathy, leading to low blood pressure and tissue perfusion inadequacy, which in turn leads to tissue damage, resulting in multiple organ failure. Nowadays, the mechanism research direction consists of:1. anti-infection and iron element; 2. the anti-inflammatory and immune suppression; 3. microcirculation with mitochondrial dysfunction; 4. sepsis related gene polymorphism.The current diagnostic criteria for sepsis comes from the new guidelines of "Surviving Sepsis Campaign". In addition to general signs of SIRS, tachycardia, shortness of breath, white blood cells increase or decrease, fever or hypothermia, mental status changes, unexplained hyperbilirubinemia, hyperlacticemia, metabolic acidosis, or respiratory alkalosis, thrombocytopenia, skin and mucosal lesions, etc can all be useful clues to sepsis.Common etiology detection methods at present, is mainly cultivation of pathogens. Rapid diagnosis of bacteria and drug sensitivity is the main development direction of diagnosis. But nowadays, clinical blood culture diagnosis is still considered the gold standard, because pathogenic bacteria can be separated and do drug sensitivity test. Rapid diagnostic methods mainly include nucleic acid testing (NAT) and matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). Procalcitonin (PCT) is still the best and the most common biomarkers.In terms of treatment, the new guidelines emphasize early recovery goals including fluid resuscitation, Clear infection, control infection focal, and using vasopressor with septic shock. Recommended dose hormone reduce, control blood sugar. Prevention of stress ulcer. Respiratory support recommended pressure small tidal volume and the highest platform. Infection of cluster treatment as soon as possible to start and finish as soon as possible.With guidelines issued, treatment dispute and progress are mainly the following aspects: 1. liquid recovery; 2. The vasopressors treatment; 3. The anti-infection treatment; 4.Anti-inflammatory and anticoagulants; 5. Corticosteroids; 6. Fever control, respiratory support, blood purification and nutritional support. Ulinastatin has anti-inflammatory and anticoagulant effect, multiple studies have shown that it can significantly improve the prognosis of sepsis, thus it can be used as alternative medicine. On the new antibacterial drugs and immune regulating drugs, there are new treatment methods.It is generally believed that the prognosis of sepsis and presence of complications are strongly associated.With declining mortality, and now study also concerned about the rehabilitation of the survivors.In traditional Chinese medicine, Sepsis has no corresponding name of disease. It has the characteristics of the variety of diseases in TCM, but mostly belongs to the category of the "exogenous febrile disease" or "febrile diseases". In order to standardize the combine traditional Chinese and western medicine diagnosis and treatment of sepsis, "the expert consensus of diagnosis and treatment of sepsis combine traditional Chinese and western medicine" was issued in 2008.Etiology and pathogenesis are mostly known through Deficiency-excess or "poison, heat, blood stasis, deficiency". Differentiation of symptoms and signs consist of three syndromes" differentiation, six meridians differentiation, Wei-Qi-Ying-Xue differentiation, Deficiency-excess differentiation. Principle and method of treatment consist of "four methods", "bacteria-endotoxin-inflammatory therapy", and so on. Zhao Chun further proposed "Bacteria-endotoxin-inflammatory-organ therapy", emphasizing the importance of organ protection.Of traditional Chinese medicine in the treatment of sepsis can be divided into clearing heat-toxin, promoting blood circulation for removing blood stasis, strengthening body resistance and catharsis such as four categories. In addition, It can also be treated with syndrome differentiation as "exogenous febrile disease", "febrile diseases" and so on. "The research and application of traditional Chinese medicine injection increased year by year. Common ones consist of "Xue Bijing", "ShenFu", "ShenMai" and "TanReqing" injection, etc. Fever is one of the main symptoms of sepsis, in order to adapt to the development of TCM treatment of high fever (sepsis), in 2014, the "high fever (sepsis) of traditional Chinese medicine diagnosis and treatment expert consensus opinions" was formulated and published. Another found that intestinal injury in sepsis has played a very important role in occurrence and development. Intestinal happened to be sepsis "hub" organs. Bowels-Relaxing of traditional Chinese medicine has good effect in the treatment of the disease.Early warning indicators and biomarkers, and treatment measures to review, the correlation between multiple drug-resistant bacteria and sepsis, sepsis of traditional Chinese medicine research model, both need more exploration.