A Study Of Clinical Effect Of Decanta And Disintoxication Treating Gastrointestinal Dysfunction In Critical Postoperative Patients

Objective:Explorer clinical effects of decanta and disintoxication treating gastrointestinal dysfunction on critical postoperative patients. Evaluate the curative effect of Jiawei Huanglian Jiedu decoction enema combining with electroacupuncture on gastrointestinal dysfunction. Provide a objective basis for optimized TCM integrated scheme for gastrointestinal dysfunction in critical postoperative patients.Method:According to the criteria of the prospective randomized controlled clinical research methods, a total of53critical postoperative patients were selected from the ICU department of Guangdong institute of traditional Chinese medicine in this study. By using the PEMS3.1, the53patients were randomly divided into two groups (trial group25cases and control group28cases). Different from the patients in the control group, in addition to the treated with western medicine, patients in the trial group were also treated with Jiawei Huanglian Jiedu decoction enema combining with electroacupuncture (bilateral st36, st37, te6) for seven days. The change of parameters of vital signs, such as postoperative heart rate and body temperature, the conditions of abdomen, bowel sound were observed after the treatment. The times of first exhaust and defecation were also recorded. On the1st3rd and7th days after the treatment, the gastrointestinal dysfunction score were recorded, and the APACHE II score was conducted on the1st and7th days after the treatment. The survival rate of7days and28days after surgery, as well as the incidence rates of pulmonitis, sepsis, MODS and any other complications were recorded. The serum DAO, D-lactate, albumin of patients were tested on the1st,3rd and 7th days after the treatment.Results:1.The P value (P>0.05) shows that there are no significant differences between the patients from the two groups in the admission clinical data, such as age, gender, history of abdominal surgery, situation of surgery, gastrointestinal dysfunction score, APACHE Ⅱ score, serum albumin, blood lactate concentration.2. The results of gastrointestinal dysfunction:①Variance of repeated data measured shows a decline in gastrointestinal dysfunction scores of two groups on the7th day after the operation(P<0.05). The gastrointestinal dysfunction scores of the patients from the two groups shows no significant difference on the3rd day after the operation, while the scores of trial group patients were significant lower than the control group (P<0.05) on the7th day.②Restoration of gastrointestinal movement function:For the first exhaust time, results from T-test show that, patients in the trial group have a mean value of the first exhaust time2.8days, while the average first exhaust time of the patients in control group was3.5days (P<0.05). For the first defecation time, results from rank sum test show significant differences between the two groups (trial group:3.72days, control group:4.57days).③The Comparison of serum DAO and D-lactate between pretherapy and after treatment shows that there was no significant difference between the two groups (P>0.05).3. Degree of critical condition and prognosis:①The APACHEⅡ scores shows significant difference between after treatment7days and pretherapy of patients in both of the two groups(P<0.05). However, the difference of the APACHEⅡscores of patients between the control group and trial group is not significant. The reducing score rate of the trial group was47.98%, which is significant larger (P<0.05) than the reducing score rate of the control group (37.63%).②Comparison of prognosis:There was no significant difference between two groups(P>0.05) for the infectious complication rate and death rate. Based on the infectious complication factor, compared the gastrointestinal scores of the two groups with the rank sum test, the average score of infected patients was much higher than the score of patients without infection, and they were significantly different (P<0.05).4. Security analysis:There were two cases of diarrhea in trial group, However, the incidence of adverse reactions was not significantly different in two groups (P>0.05).Conclusion:Gastrointestinal dysfunction which is one of the risk factors for the critical postoperative patients can cause infectious complication. The TCM therapeutic scheme, Jiawei Huanglian Jiedu decoction enema combining with electroacupunctur, can improve postoperative gastrointestinal motility function recovery. As the results of this study shows that decanta and disintoxication can help to reduce the degree of critical condition by improving postoperative gastrointestinal function.