Protective effect of DaHuang Fuzi Decoction on hemorrhagic shock secondary to acute lung injury in patients

Abstract

Objective To discuss protective effect of DaHuang Fuzi Decoction (a Chinese herbal preparation made of Rheum palmatum L and Aconitum carmichaeli Debx) on hemorrhagic shock induced by acute lung injury in patients.Methods A prospective,muhiple-center,randomized (random number) and controlled clinical trial was carried out in 87 adult patients with hemorrhagic shock secondary to acute lung injury admitted in intensive care unit (ICU) of 3 tertiary care hospitals in Dalian city.Patients were randomly (random number) divided into control group (n =42) and DaHuang Fuzi Decoction enemas group (experimental group,n =45).Of 42 patients of control group,there were 28 male and 14 female with average age (39.68 ± 15.77) years ranged from 20 to 64 years,and in experimental group,there were 30 male and 15 female with average age (42.12 ± 14.87) years ranged from 20 to 68 years.The serum levels of TNF-α,C-reactive protein (CRP),lactic acid and endotoxin,and extravascular lung water index,ratio of extravascular lung water to intrathoracic blood volume (EVLW/ITBV),MAP,cardiac index (CI),and static lung compliance and airway resistance were determined in each group before and 1d,3d,7d after treatment.The data including the length of time consumed for respiration support with mechanical ventilation and length of time required for correction of hypoxemia to normal oxygenation resumed and length of hospital stay and mortality were analyzed.Results Compared with control group,DaHuang Fuzi Decoction decreased the levels of serum TNF-α,CRP,blood lactic acid,endotoxin,VLWI and EVLW/ ITBV in experimental group (P ＜ 0.05 or P ＜ 0.01).Static lung compliance in experimental group were enhanced on 3 d,7 d after treatment,but 7 days after treatment with DaHuang Fuzi Decoction,the airway resistance in experiment group were lower than that in control group on 7 day without DaHuang Fuzi Decoction treatment.Compared with control group,in experimental group,the length of time consumed for mechanical ventilation support was ([(7.82 ± 1.54) d vs.(5.26 ± 1.28) d,P ＜ 0.05],the length of time required for restoration of normo-oxemia was [(82.42 ± 14.61) h vs.(62.34 ± 11.27) h,P ＜ 0.01],length of hospital stay was [(13.85 ±2.94) d vs.(10.57 ±2.05) d,P ＜0.05] and mortality was (7.5％ vs.2.5％,P ＜ 0.01).Conclusions DaHuang Fuzi Decoction could reduce extravascular lung water index and airway resistance,enhance static lung compliance,improve oxygenation index by inhibiting enterogenous endotoxin and TNF-α,and then shorten the mechanical ventilation support time and normal oxygenation restoration time,and reduce mortality of hemorrhagic shock induced by acute lung injury in patients. Key words: Hemorrhagic shock; Acute lung injury; DaHuang Fuzi Decoction; Endotoxin; Extravascular lung water; Static lung compliance ; Airway resistance ; Mortality ; Patient