Influence Of Shenmai Injection (SMI) Combined CRUSADE Score On The Research Of Sepsis Coagulopathy

Objective:1. To investigate the value of CRUSADE score on the occurrence of DIC in sepsis with deficiency both qi and yin of blood stasis syndrome.2. Through the prospective random single-blind controlled trials, to clear the influence SMI in patients with sepsis coagulation dysfunction,in order to spread further researches on large sample clinical research lays the foundation.Methods:1. A prospective analysis (2014.5-2015.02 Guangdong Provincial Hospital of TCM ICU) included 50 patients with sepsis coagulation dysfunction. They are divided into treatment and control groups according to the using SMI or not, Two groups of patients’APACHE Ⅱ score, CRUSADE score, DIC score were r-ecorded at cape and 5 days in hospital, as well as routine blood test, co-agulation, D-dimer and death, then analysis the correlation of them and the contrast of before and after treatment.Results:The mortality rate of 50 cases of patients with sepsis was 38%. The average APACHE Ⅱ score was 16.38 points, CRUSADE score 49.16 points, with DIC score 4.1 points. ROC curve area of CRUSADE score in predicting the dominant DIC was 0.701, and there was statistical significance;CRUSADE and APACHEII score in dominant DIC single factor analysis and logistic regression analysis were statistically significant. The dominant DIC of the treatment group and control group comparison was statistically significant in non-high-risk group(P< 0.05).Correlation analysis showed that CRUSADE score were positively correlated with PT level, the linear regression equation Y=12.578+2.091X(X behalf of the PT, Y represent CRUSADE score). CRUSADE score has no correlation with other coagulation indicators. CRUSADE score and APACHEII scores were positively correlated, the linear regression equation Y= 37.136+0.734X (X represents the APACHEII scores, Y represent CRUSADE score). CRUSADE rating scores were positively correlated with DIC, the linear regression equation Y= 25.755+5.709X (X represents the DIC score, Y represent CRUSADE score). CRUSADE score has no correlation with blood routine indexes.2. According to the method of block randomized patients were randomly divided into wheat group and the control group, (1)Baseline levels of both groups, in age, sex, past medical history, APACHE II score, CRUSADE score, DIC score, blood routine, coagulation, D-dimer difference is not significant. (2)SMI group compared with control group, after treatment the blood coagulation indexes comparison difference was statistically significant (P< 0.05);And SMI group before and after treatment comparison of PT, at, INR, D-D, FIB was statistically significant (P< 0.05);The control group before and after treatment comparison of PT, AT, FIB was statistically significant (P< 0.05). (3) And SMI group compared with control group, the APACHEII scores after treatment, DIC score, HB comparative difference was statistically significant (P< 0.05), CRUSADE score two groups compare (P= 0.06);And SMI group before and after treatment comparison CRUSADE score, APACHEII scores, DIC score, NEUT have statistical significance (P< 0.05), the control group before and after treatment comparison APACHEII scores, HB was statistically significant (P< 0.05). (4) the 28d survival rate of two groups had difference (P=0.019) (5) Age、group and APACHEII score in death single factor analysis and logistic regression analysis were statistically significant.Conclusion:1. (1) Sepsis patients blood coagulation dysfunction of deaths associated with APACHEII scores on admission and age, APACHEII score, the higher the risk, the greater the age death;And has nothing to do with the CRUSADE score and DIC score on admission to hospital. (2) CRUSADE score and APACHEII scores and DIC score has good correlation, early intervention in patients with non dominant DIC patients’mortality rate is lower than without intervention group obviously.2. (1) SMI can improve the 28 d survival rate in patients with sepsis. (2)SMI can significantly improve the extension of APTT and PT, sepsis patients can make higher FIB, PLT increase;D-D is reduced, thus improve blood coagulation dysfunction in patients with sepsis. (3) SMI therapy can improve prognosis but more CRTs are needed.