Application Of ChenPiRenShen Decoction In The YinJieYangTuo Type Of Septic Shock

Objective:To explore the objective of fluid resuscitation guided by bedside ultrasound combined with biological markers in the early stage of septic shock.In patients undergoing fluid resuscitation,the effect of ChenPiRenShen decoction on hemodynamics of septic shock patients with syndrome type of YinJieYangTuo was observed while using norepinephrine,and the effect of ChenPiRenShen decoction on the treatment of early stage of septic shock was explored.Method:Part one A total of 81 patients with syndrome type of YinJieYangTuo who met the inclusion criteria and exclusion criteria were selected.Bedside ultrasound combined with biological markers were used to guide fluid resuscitation.The data of Fluid volume,fluid resuscitation index,biological marker,cardiac function index,hospitalization time and hospital mortality were calculated,and compared with the data of ARISE study.Part two According to the criteria of shedding and termination of the experiment,52 patients were selected and randomly divided into two groups according to 1:1.Each group had 26 patients:Conventional treatment group:Fluid resuscitation was performed,and if the patient's hemodynamics remained unstable,central venous catheterization was performed and vasoactive agents were administered.Chinese medicine intervention group:On the basis of the control group,when the hemodynamics tended to be stable,the intervention of ChenPiRenShen decoction was added.When vasoactive agents were discontinued,the ChenPiRenShen decoction was continued for 72 hours.Observe baseline and time of using norepinephrine;Total norepinephrine/per kilogram of body weight;LCR of 0-6h;the time it takes for lactic acid to reach the standard(<2mmol/L);mechanical ventilation time;hospitalization time;hospital mortality.And observe the possible adverse event during the study.SPSS 22.0 was used for statistical analysis.Result:Part one In the first 72 hours of this study,the heart rate and Lac showed a downward trend,the MAP showed an upward trend,and the urine volume was basically maintained at 1.0ml/kg.In the first 24 hours,the IVCD was controlled below 20mma ? IVCD was more than 25%,and RVEDA/LVEDA was<0.6.In this study,th e cumulative liquid volume within 6h was 1525±345ml,average APACHE II score was 18.12±6.48,the median length of hospital stay was 10 days,and the hospital mortality was 18.5%,the normal treatment group in the study of ARISE were 1713±1401 ml,15.5±6.5 points,8.5 days and 15.7%.The EGDT group were 1964±1415ml,15.4±6.5 points,8.2 days,and 14.5%.Part two1.Baseline comparison:the gender,age,body weight,APACHE II score,underlying disease and the infection sites had no statistical difference(p>0.05).2.There was no statistically significant difference in the time to start norepinephrine between the two groups.The total duration of norepinephrine use in the experimental group was slightly less than that in the control group,but there was no significant difference(p>0.05).Total norepinephrine/per kilogram of body weight and mechanical ventilation time in the experimental group were significantly less than those in the control group(p<0.05).There were no significant differences between the two groups in LCR of 0-6h,hospitalization time and hospital mortality(p>0.05).3.Logistic regression model was used for analysis,and it was found that the intervention of ChenPiRenSheng decoction was a protective factor for total norepinephrine/per kilogram of body weight(OR=0.995,95%CI 0.992-0.999,p=0.012),but had no significant effect on time of using norepinephrine,LAC of 0-6h,the time it takes for lactic acid to reach the standard,mechanical ventilation time,hospitalization time and hospital mortality.4.No obvious adverse events occurred in the two groups.Conclusion:In the early stage of septic shock patients in our department,fluid resuscitation strategy guided by bedside ultrasound combined with biological markers was adopted,and achieved better fluid control effect.IVCD and right cardiac function combined with biological markers and hemodynamic indicators to guide patients' fluid management can optimize fluid resuscitation.The use of ChenPiRenShen decoction can effectively reduce the use of vasoactive drugs in patients with septic shock,which plays a certain role in the treatment of septic shock.