| Background:Gastrointestine (GI) is regarded as the1st cause of MODS and plays a role in the pathophysiological process of SIRS/MODS, owing to its special intestinal mucosal barrier function important to occurrence and prognosis of MODS apart from its vital function of digestion, absorption, immunity and internal secretion. Hit from stressors(severe trauma, burns, severe infection and shock, etc.) could cause intestinal mucosal ischemia and anoxia, increase and release of endotoxin, endogenous cell factors and inflammatory mediators in blood and immunologic mechanism damage and gastrointestinal disorder, which, as a result, brings gastrointestinal mucosal barrier function damage and micro-ecological environment unbalance and worsens gastrointestinal mucosal edema, erosion and ulcer. Secondary onset of enterogenic infection and translocation could induce some conditional pathogenic bacterium to invade in tissues and organs and circulatory system, leading to damage of remote organs and relevantly causing SIRS/MODS. GI bleeding is the severest gastrointestinal disorder with a high mortality when once occurring. The latest western medicine treatment mainly contains improvement of GI blood perfusion and micro-circulation against shock, promotion of peristalsis and recovery of GI power against enteoparalysis, lessening of GI ischemia and reperfusion injury with use of oxygen free radical scavenger, promotion of ulcer surface repair with PPIs against gastric acid secretion, consolidation of intestinal biological barrier for micro-ecological environment balance with probiotics and timely enteral nutrition with reasonable dispensing. TCM and its medicine has been playing an important role in gastrointestinal dysfunction in critical illness in the past20years, among which purgative therapy and method of benefiting Qi and invigorating the spleen has been studied and applied to clinical treatment widely. ICU of Xiyuan Hospital has been carrying out some relevant work on gastrointestinal dysfunction including standardizing routine work of diagnosis and treatment and putting TCM characteristic treatment into effect such as clysis for purgation with Rhubarb Powder and infusion of Invigorating Qi and Hemostatic Decoction through gastric tube with affirmative effects. As there’s little clinical study on GI bleeding of gastrointestinal dysfunction in critical illness, this study launches on the basic clinical practice.Objective:To study clinical effects of Invigorating Qi and Hemostatic Decoction on MODS complicated by GIBMethods:To use prospective and completely random control research method. Study30cases from patients checked in ICU, meeting the diagnosis criteria for MODS and GI bleeding, with syndrome differentiation as Qi and Yin Deficiency according to diagnosis/inclusion/exclusion criteria. To adopt Random CRT method and divide30cases into2groups, the control group and the treatment group for15cases respectively. To record the age, gender, main causes of being checked in ICU, APACHE Ⅱ Score and gastrointestinal dysfunction score of each patient. To survey and record intra-abdominal pressure(IAP), borborygmus, APACHE Ⅱ Score, gastrointestinal dysfunction score and TCM syndrome score before the experiment and day1,3and7. To count days of occult blood (OB) test turning out negative and total effective rate of each group according to evaluation criteria of curative effect of TCM syndrome respectively and analyze the data with statistics.Results:(1)IAP:For the control group, IAP is (11.81±2.27)cmH2O before the experiment and (10.54±2.50) cmH20on day7with statistical difference(P<0.05). For the treatment group, IAP is(13.15±2.74)cmH2O before the experiment,(12.13±2.04) cmH2O on day3and (10.35±1.49) cmH2O on day7, compared IAP on day3and7to that before the experiment with statistical difference(P<0.05) and significant difference(P<0.01) respectively. Compare the two groups with no statistical difference.(2)Borborygmus:For the control group, borborygmus being (1.53±0.64)f/min before the experiment,(2.40±0.51) f/min on day3and (3.67±0.72) f/min on day7, compared borborygmus respectively on day3and7to that before the experiment both with significant difference(P<0.01). For the treatment group, borborygmus being (1.20±0.56)f/min before the experiment,(2.73±0.70) f/min on day3and (4.00±0.65) f/min on day7, compared borborygmus respectively on day3and7to that before the experiment both with significant difference(P<0.01). Compared to the control group, borborygmus of the treatment group on day3with significant difference (P<0.01) and day7with statistical difference (P<0.05).(3) OB test turning out negative needed (4.77±1.09)days for the control group and that did (3.92±0.86)days for the treatment group with statistical difference(P<0.05) compared to the former.(4)APACHE II Score:For the control group, APACHE II Score being (14.60±3.62)points before the experiment,(12.67±3.46) points on day3and (11.20±3.38) points on day7,compared APACHE II Score respectively on day3and7to that before the experiment both with significant difference(P<0.01). For the treatment group, APACHE II Score being (15.73±3.86) points before the experiment,(12.87±3.20) points on day3and (10.53±3.11) points on day7,compared APACHEⅡ Score respectively on day3and7to that before the experiment both with significant difference(P<0.01). Compared to the control group, APACHE Ⅱ Score of the treatment group on day7with statistical difference(P<0.05).(5)Gastrointestinal dysfunction score:For the control group, gastrointestinal dysfunction score is (2.00±0.65) points before the experiment and (1.53±0.52) points on day7with statistical difference(P<0.05). For the treatment group, gastrointestinal dysfunction score is (2.13±0.52) points before the experiment and (11.07±0.59) points on day7with significant difference(P<0.01). Compared to the control group, gastrointestinal dysfunction score of the treatment group on day7with statistical difference (P<0.05).(6)Bleeding syndrome score:For the control group, bleeding syndrome score is (5.60±2.75) points before the experiment,(3.80±2.11) points on day3and (0.60±1.68) points on day7with significant difference (P<0.01) respectively. For the treatment group, bleeding syndrome Score being (6.20±2.39) points before the experiment,(2.80±2.11) points on day3and (0.40±1.10) points on day7,compared bleeding syndrome Score respectively on day3and7to that before the experiment both with significant difference(P<0.01). Compared to the control group, bleeding syndrome score of the treatment group on day3with statistical difference (P<0.05).(7)Other TCM syndrome score:For the control group, other TCM syndrome score is (11.20±1.47) points before the experiment and (8.80±2.08) points on day7with significant difference(P<0.01). For the treatment group, other TCM syndrome Score being (12.13±1.19) points before the experiment,(9.47±1.46) points on day3and (6.40±1.99) points on day7,compared other TCM syndrome Score respectively on day3and7to that before the experiment both with significant difference(P<0.01). Compared to the control group respectively, other TCM syndrome Score of the treatment group on day3and day7with significant difference (P<0.01).(8) Evaluation criteria of curative effect of TCM syndrome: Cases of significantly effective, valid and invalid werel,10and4for the control group and those3, Hand1for the treatment group with statistical difference (P<0.05).Conclusions:Compared days of OB test turning out negative to the control group with statistics difference, treatment with Invigorating Qi and Hemostatic Decoction could improve borborygmus,APACHE Ⅱ Score, gastrointestinal dysfunction score and other TCM syndrome score, which shows Invigorating Qi and Hemostatic Decoction with some certain hemostatic effect and gastrointestinal function protect effect. What’s more, compared evaluation criteria of curative effect of TCM syndrome to the control group with statistical difference (P<0.05), which shows Invigorating Qi and Hemostatic Decoction with effects on improving syndrome of deficiency of Qi and Yin. |
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