Clinical Observation Of Senile Severe Sepsis Intervened By Shenfu Injection In The Acute Deficiency

Object iveThe indicate of the sepsis is rising, and the fatality rate remains high. At present,its pathogenesis is still not completely clear. Modern western medicine mainly depends on symptomatic and supportive treatment, while TCM agrees that deficiency in right qi is the internal cause of exogenous pathogenic toxin penetrating into the exterior of the body and " acute deficiency pattern" is the main patho-mechanism of the sepsis. Therefore, we claim to treat for sepsis by supporting right in the early stages of the disease.The thesis is to discuss the clinical curative effect of supporting right for sepsis, by adding qi-tonifying and yang-warming medicinal-Shenfu injection to treat elderly patients with severe sepsis.MethodsThe study was simple, random and control.The subjects were 60 aged hospitalized patients with severe sepsis in accordance with the inclusion criteria. They were randomly divided into the observation group and the control group according to the ratio of 1:1.The course of treatment for two groups both took 7 days. In the study, the changes of associated indicators between two groups were observed, such as APACHEII scale scores, the lactic acid (Lac) and procalcitonin(PCT), whether MODS occurs were recorded, and fatality rate in the 28 days, ICU hospitalization days, and ICU hospitalization days were summed up.Research data was input to the computer so as to establishing a database, and the data was analyzed by SPSS.18.0 statistical software. Quantitative data was shown by meani standard deviation, comparison between two means by t-test. Non-normal distribution used Wilcoxon signed-rank test.And qualitative data was expressed by frequency rate and comparison between rates was processed by chi square test or exact probability.We set a< 0.05, and when P<0.05, the difference was statistically significant.Results1. After treatment, the Lac of the experimental group declined clearly compared with before treatment.By paired t test, the difference was statistically significant(P<0.01),while the control group wasn’t so(P >0.05). The difference of the lactic acid and the lactate clearance rate between the two groups of patients had statistic difference (P<0.05) by paired t test. Among them, the lactate clearance of the experiment group declined more than the control group, the different had statistical significance(P<0.01)2. The indicate of MODS and the fatality rate in the 28 days of the experimental group reduced in comparison with the control group, and the difference had statistical significance (P<0.05). The death rate in 7 days between the two groups had no significant statistical difference (P> 0.05). ICU hospitalization days and hospitalization days between two groups of the patients were categorical data and belonged to non-normal distribution, and by Wilcoxon signed-rank test, the difference between the two groups wasn’t statistical significant (P>0.05).3. Trough making a ROC curve of 60 patients taking part in the study, the PCT after treatment and APECHEII before and after treatment was significant to the judgment of the indicate of MODS (P<0.05). The Lac after treatment was significant to the indicate of MODS and the death rate in 28 days(P< 0.05). Stratified analysis was carried out on the tipping point, and we found APECHEII scales score> 14 after treatment and Lac> 1.6mmol/L after treatment had statistical significance in judging the indicate of MODS (P <0.05).Conclusions1. After treatment, the experiment group by adding Shenfu injection could effectively clear the lactic acid compared with the control group, and the difference of the lactic acid and the lactate clearance reduced significantly before and after treatment in comparison with the control group.So we deduce that adding Shenfu injection can improve circulation perfusion, resist to oxidation, and increase the body’s oxygen utilization and metabolism. What’ s more, it may ensure perfusion and oxygen supply for organs, issues and cells, effectively prevent sepsis from becoming into MODS, and at the same time, reduce the fatality rate in 28 days. APECHEII scale scores>14 after treatment and Lac>1.6mmol/L after treatment means a lot to predict the indicate of MODS.2. The severe sepsis of the elderly patients has the patho-mechanism characteristics of acute deficiency pattern when right qi is not enough to overcome evil qi, which is principally shown as yang collapse. Supporting right is used as the basic point of TCM treatment for sepsis, which contributes to improve the patients’conditions and prognosis. We believe that it may be the starting point of the treatment for sepsis with combination of TCM and modern western medicine.