Study On The Syndrome Differentiation And Transmission Principles Of TCM In Systemic Inflammatory Response Syndrome And Multiple Organ Dysfunction Syndrome

Background: Multiple organ dysfunction syndrome(MODS) is serious complication of wound, shock, infection and post-CPR. Nowadays it becomes the research focus of the international medical group and the biggest challenge of critical medicine, wound medical science, emergency in the world. Nowadays there are so much study about pathogenesis and treatment of MODS and sorts of new therapeutic regimen and tool, however, MODS is still one of the highest mortality of clinic critical disease. Systemic inflammatory response syndrome(SIRS) means human body responsed for various stimulation or attachment, such as infection, hypoxia, wound, necrosis which originated systemic inflammatory immunoreaction out of control. Both of sorts of infective and un-infective element can cause SIRS. SIRS is the basic reason and important process of MODS. MODS is serious complication and persistent developed consequence of SIRS.There is no name of MODS and delineation of correlated and similar symptom in TCM. Recently MODS is called "ZANG-organ exhaust syndrome" .The cause of MODS to be considered is the deficient body invaded by exogenous pathogen induced to functional activity of QI being not smooth, aberration of catharsis, backrun of QI and blood and segregation of yin-yang. Although a deal of aspect about treatment of MODS in TCM is investigated, there is seldom research about etiopathogenesis and syndrome of TCM, which is lack of systematic research about transmission and syndrome principles in entrails' process of occurrence and development in MODS. Utilizing the thought of syndrome differentiation in TCM and probing into pattern law of TCM with entrails' function correlated with Chinese medicine basic theory synthetically in SIRS/MODS, it is important for us to know the etiopathogenisis and pathogenesis of SIRS/MODS in Chinese medicine theory and determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs.Objcetive: Making use of Chinese medicine basic theory to carry on differentiation of symptoms and signs for classification of syndrome to SIRS/MODS, we could find out transmission and syndrome principles about entrails of TCM, put forward the concepts of "priming entrail" and "pivot entrail" and set up the theoretical system of differentiation of symptoms and signs of SIRS/MODS in TCM. By means of offerring the theoretical foundation for treating and preventing transmission of TCM in SIRS/MODS, we could grasp occurrence and development better in SIRS/MODS. According to the theory of "following the prognosis of a disease" and "preapring for progress of disease" in TCM, we could prevent transmission of a disease and protect ZANG-organ which transmit not yet.Method: On the basis of the diagnostic criteria in SIRS/MODS, we internalized 91 patients(the time of surviving>72 hours) accorded with standard in ICU of the second affiliated hospital of Guangzhou university of Chinese medicine (Guangdong Province hospital of TCM), which were from January 2006 to April 2008). Combined the main sign, the evidence assisted and tongue/nervure to judge entrails involved, the patients were analysed and differentiated pathological conditions in accordance with entrails and the eight principal syndromes in ICU 0h, 24h and 72h. According to pattern of syndrome and regularity of evol in the patients, combined ancient modern literature, clinical experience and basic theory of Chinese medicine, we could confirm transmission principles of TCM in five viscera and put forward the concepts of "priming entrail" (the first ZANG-organ involved when MODS took place)and "pivot entrail" (the ZANG-organ involved when pathogenetic condition aggravated and patients died rapidly).We set up the database and deal with the data with the software of SPSS13.0.Result:(1)The death rate in MODS was significantly higher than that in SIRS(P<0.01).Through logistic regression analysis, SIRS/MODS and number of entrail damaged in 72h influenced death prominently.(2)The relation between number of entrail damaged and outcome: the difference of SIRS/MODS in ICU 0h was no statistical significance(P>0.05), and the fatality rised with the number of entrail damaged in 24h and 72h significantly (P<0.01).(3) Compared with SIRS group and MODS group: the difference of number of entrail damaged in ICU 0h was no statistical significance (P>0.05), the number of entrail damaged in MODS group was significantly higher than that in SIRS group in 24h and 72h(P<0.01).(4)Compared with death group and improvement group: the difference of number of entrail damaged in ICU 0h was no statistical significance(P>0.05), the number of entrail damaged in death group was significantly higher than that in improvement group in 24h and 72h(P<0.01).(5)Correlation analysis of entrail damaged and outcome was prominent positive correlation in 24h and 72h(P<0.01).(6)Compared with the degree of cold and pyretic: the difference was no statistical significance in ICU 0h, 24h and 72h(P>0.05); compared with SIRS group and MODS group, death group and improvement group, the difference was no statistical significance (P>0.05); the difference in SIRS group, MODS group, death group and improvement group was no statistical significance (P>0.05). The difference of "cold and pyretic syndrome" and outcome was no statistical significance in three time point(P>0.05).(7) From asthenia to sthenia: 24h>72h>in ICU 0h (P<0.05); compared with SIRS group and MODS group, death group and improvement group, the difference was no statistical significance(P>0.05). SIRS group: 24h>in ICU 0h>72h (P<0.05); death group: 72h>24h>in ICU 0h(P<0.05). The difference in MODS group and improvement group was no statistical significance(P>0.05).The difference of"asthenia and sthenia syndrome" and outcome was no statistical significance in ICU 0h(P>0.05), sthenia syndrome in 24h and asthenia syndrome in 72h were high mortality(P<0.05).(8) Compared with SIRS group and MODS group, death group and improvement group, the difference of differentiation of symptoms and signs group was no statistical significance in three time point(P>0.05).(9)Compared with primarily sickness group: the difference of cold and pyretic syndrome was no statistical significance in ICU 0h, 24h and 72h(P>0.05); primarily sickness influenced the degree of asthenia and sthenia in ICU 0h(P<0.05).There was no statistical significance in 24h and 72h (P>0.05).(10)Correlation analysis of "asthenia and sthenia syndrome" and spleendamaged was positive correlation in ICU 0h(P<0.05). Correlation analysis of"asthenia and sthenia syndrome" and bowel was prominent negative correlationin ICU 0h(P<0.01); Correlation analysis of "asthenia and sthenia syndrome"and nephros was negative correlation in 72h(P<0.05).(11) Patients of MODS in three time point, total number of entrail damaged in arranged from more to less:pulmo>bowel>cardia>nephros>spleen>encephalon>hepar. The increase and decrease number of entrail damaged in 24h arranged from more to less: bowel>spleen>hepar=nephros>cardia>encephalon>pulmo. The increase and decrease number of entrail damaged in 72h arranged from more to less: encephalon>hepar>nephros>spleen=bowel>pulmo>cardia. The total death toll of each entrail damaged in proportion of total patients damaged arranged from more to less: nephros>cardia>spleen>bowel>pulmo>encephalon>hepar.Conclusions:(1)The fatality of SIRS/MODS rised with the number of entrail damaged. With the time passed, sthenia syndrome turned into asthenia syndrome and the fatality of SIRS/MODS rised. Furthermore, what the differentiation of symptoms and signs was sthenia or asthenia had nothing to do with primarily sickness gradually.(2) If spleen was damaged in patients of SIRS/MODS in ICU 0h, the patients would appear asthenia syndrome. If intestine was damaged in ICU 0h, the patients would appear sthenia syndrome. If nephros was damaged in ICU 72h, the patients would appear asthenia syndrome.(3)The progress of disease in eight principal syndromes of TCM might be: excess-heat syndrome/simple sthenia syndrome→(asthenia mixed with sthenia syndrome)→deficiency of both vital energy and yin syndrome/asthenia-heat syndrome→yin and yang exhaustion syndrome.(4)The priming entrails might be pulmo and the pivot entrails may be nephros in patients of MODS. The five viscera progress of disease in patients of MODS might be pulmo→cardia→spleen→hepar→nephros.