| Objective To study the effect of the early cluster of TCM measures to prevent patients with severe sepsis of acute gastrointestinal injury.Methods Adopting the method of prospective studies,296 cases of patients with severe sepsis in ICU were randomly divided into control group of 150 cases and treatment group of 146 cases.The control group used conventional treatment.On the basis of conventional treatment,treatment group used combined with the cluster of TCM measures(fill the stomach with herbal soup in dialectical therapy,acupuncture point of the Stomach Meridian of Foot-Yangming,apply umbilicus with Mirabilite,clyster with purgation mistura).Record patients’ D-lactate(D-lac),Diamine oxidase(DAO)and endotoxin,Motilin(MTL),Gastrin(GAS),intra-abdominal pressure(IAP)after treatment on Dayl,3,7;albumin(ALB)and Prealbumin(PA);MODS score,SOFA score and APACHE Ⅱ score.To compare the incidence of AGI and GIF score on Day 7,and compare two groups’ mechanical ventilation time,ICU admission time and 28-day mortality,gastrointestinal attribution of mortality.Results(1)gastrointestinal function indicators:D-lac,DAO,endotoxin of treatment group were significantly lower than the control group on the Day7,respectively for(321.65±138.7 vs 377.79±204.93)mg/l,(10.09±4.55 vs 12.36±10.09)u/ml,(0.59±0.17 vs 0.64±0.59)eu/ml,differences were statistical significance(all P<0.05).MTL of treatment group was significantly higher than control group on the Day3、7,respectively for(324.12±201.30 vs 274.08± 165.02)ng/l,(423.02±318.69 vs 320.54±230.24)ng/l,differences were statistical significance(all P<0.05).GAS of treatment group was significantly lower than control group on the Day3、7,respectively for(183.79±113.08 vs 216.24±120.75)ng/l,(176.54±99.14 vs 214.32±121.37)ng/l,differences were statistical significance(all P<0.05).IAP of treatment group was significantly lower than control group on the the Day3、7,respectively for(9.16±4.12 vs 11.23±9.16)mmHg,(10.28±2.61 vs 11.59±10.28)mmHg,differences were statistical significance(all P<0.05).(2)The incidence of AGI and GIF score:the incidence of AGI of treatment group and control group were 47.26%vs 58.67%,differences were statistical significance(P<0.05).GFI score of AGI Ⅱ,Ⅲ of treatment group were significantly lower than control group,respectively for(2.16±0.85 vs 2.68±0.98)points,(2.41±0.95 vs 2.94±0.96)points,differences were statistical significance(all P<0.05).APACHE Ⅱ score of AGI Ⅱ,Ⅲ,Ⅳ of treatment group were significantly lower than control group,respectively for(11.27±2.00 vs 12.15±2.46)points,(10.18±1.87 vs 11.06±2.02)points,(13.15±1.59 vs 13.72±1.89)points,differences were statistical significance(all P<0.05).The incidence of AGI in different levels of APACHE Ⅱ score(<10,10～20groups)were significantly lower than control group,respectively for(0 vs 25%),(31.34%vs 51.43%),differences were statistical significance(all P<0.05).(3)nutritional status:prealbumin of treatment group on the Days 7 and the Day leaving the ICU were significantly higher than control group,respectively for(214.78±32.40 vs 182.51±29.40)mg/l,than 161.82(193.70±27.03 vs 161.82±193.70)mg/l,differences were statistical significance(all P<0.05).(4)critical score:APACHE Ⅱ score of treatment group on the Day7and the day leaving the ICU were significantly lower than control group,respectively for(11.06±2.02 vs 10.18±11.06)points,(11.27±2.00 vs 12.15± 11.27)points;SOFA score of treatment group was significantly lower than control group,respectively for(4.40± 1.56 vs 5.67± 4.40)points,(5.471±1.67 vs 6.13±5.47)points,(all P<0.05).MODS score of treatment group were lower than control group,respectively for(2.88± 0.96 vs 3.16±0.92)points,(3.73± 1.30 vs 3.93±3.73)points,but differences were no statistical significance(P>0.05).(5)the prognosis:mechanical ventilation time of treatment group was obviously less than the control group(9.28±3.76 vs 10.39±9.28)d;Time to retain the ICU was obviously less than the control group(14.21±7.88 vs 18.51±14.21)d;28-days mortality and gastrointestinal attribution of mortality of treatment group were obviously less than the control group,respectively for 25.34%vs 36.67%,2.74%vs 8.67%,differences were statistical significance(all P<0.05).Conclusion The early cluster of TCM measures for patients with severe sepsis can prevent the happening of the AGI,and improve its prognosis. |
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