Characteristics And Treatment Research Of Organ Impairment In Early Stage Of Dachang Fushi Syndrome Induced By Acute Abdomen

Objective: Through the observation of Dachang Fushi syndrome induced by acute abdomen complicated with multiple organ dysfunction syndrome(MODS) in patients with clinical data,analysis and discuss the developmental and variable rules in early organ function impairment of Dachang Fushi syndrome induced by acute abdomen,analysis the correlation between numbers of organ damage and the prognosis of patients,analysis independent risk factors of Dachang Fushi syndrome caused by acute abdomen and the experiences of prevention and cures. In order to provide some clinical evidences for judging the prognosis correctly and the combination of traditional Chinese and Western medicine treatment.Methods: The completed case data of patients with Dachang Fushi syndrome induced by acute abdomen complicated with multiple organ dysfunction syndrome admitted to the surgical intensive care unit(SICU)in the Tianjin Nankai Hospital from 2009 to 2013 were retrospectively analyzed,a total of 91 patients. Among them,59 cases were male and 32 cases were female.The average age was(51.72+13.01) years old.Their APACHE ? scores are(14.26+6.93) points in 24 hours after patients were admitted to hospital.All patients with Dachang Fushi syndrome caused by acute abdomen received conventional Western medicine comprehensive therapy combined with tongligongxia herbs Qing feichengqi Granules. After enrollment,the patients were given related examinations immediately,in accordance with the criteria diagnostic procedures of MODS,observe and record the patient into the hospital(d1),3 days after treatment(d3), the 7 days(d7) and day 14(d14) within the occurrence of each organ dysfunction,tally the incidence rates and occurrence time of each organ dysfunction in the early stage of Dachang Fushi syndrome caused by acute abdomen and APACHE ? score,TCM syndrome integral,mortality rate,length of hospital stay in surgical ICU,the total length of hospital stay,hospital expenses and so on. Unconditional multivariate Iogistic regression analysis method(Enter) were adopted to analysis independent risk factors of Dachang Fushi syndrome caused by acute abdomen.Results:(1) In all the 91 cases,gastrointestinal tract was generally involved in(96.70%),and from high to low order,the incidence of organ impairment was that of the gastrointestinal tract,lung,heart,metabolism,kidney,liver,circulation,coagulation, and brain. Severe complications included acute respiratory distress syndrome(ARDS) in 31 cases(34.07%),acute liver failure in 15 cases(16.48%),shock in 19 cases(20.88%),acute renal failure(ARF)in 12 cases(13.19%),gastrointestinal bleeding in 13 cases(14.29%),coagulation disorder in 10 cases(10.99%),and pancreatic encephalopathy in 8 cases(8.79%). There was no significant difference among the time of occurrence. More complications focus within the 7 days of hospital,including acute respiratory distress syndrome,shock,acute kidney function failure occurred earlier and gastrointestinal bleeding,blood coagulation dysfunction,pancreatic encephalopathy occurred later.(2)Patients with Dachang Fushi syndrome induced by acute abdomen each time(1?3?7d) the number of organs dysfunction involved and APACHE ? scores were positively correlated [correlation coefficient(r) = 0.358,0.240,0.283,P<0.05],TCM syndrome integral were positively correlated(r =0.273?0.317?0.245,P<0.05),and the mortality rate in 14 days was positively correlated(r=0.329,P<0.05),and the length of stay in the surgical ICU was positively correlated(r=0.353,P<0.05),and the total length of stay in the hospital was positively correlated(r=0.275,P<0.05),and cost of hospitalization were positively correlated(r=0.398,P<0.05);APACHE ? score and 14 d mortality rate was positively correlated(r = 0.385,P<0.05),TCM syndrome integral and 14 d mortality rate was positively correlated(r = 0.279, P<0.05).(3)In the whole group of patients,16 cases died within 14 days,including 10 cases of male,female 6 cases,and the mortality rate was 17.58%. Death is closely related to the risk factors for acute respiratory distress syndrome and acute renal failure.Conclusions:(1)The organ impairment in the early stage of Dachang Fushi syndrome induced by acute abdomen characterized as that of the gastrointestinal tract,lung,heart,metabolism,kidney and liver,the most commonly involved.Serious complications of acute respiratory distress syndrome and shock have higher incidence rate.There was no significant difference among the time of occurrence.More complications focus within the 7 days of hospital.(2)The numbers of organ damage were significantly associated with prognosis of patients.(3)The multivariate logistic regression analysis showed that acute respiratory distress syndrome and acute renal failure were related independent high and dangerous risk factors with Dachang Fushi syndrome induced by acute abdomen.(4)In traditional Chinese medical,the exterior and interior relation of lung and large intestinal as the guide,on the basis of western treatment,giving tongligongxia herbs Qing feichengqi Granules,which could reduce the mortality of patients with Dachang Fushi syndrome induced by acute abdomen,prolong the survival time of patients and have remarkable curative effect. Therefore the combined treatment of Chinese and Western medicine is to be the developing direction of the prevention and cure of the multiple organ failure caused by Dachang Fushi syndrome.