| Objective:①To understand the incidence of diarrhea in critically ill patients with the age, gender, primary disease, the relationship between APACHEII score and prognosis.②To understand the related factors in critically ill patients with diarrhea, and the distribution of TCM syndrome types. And help us to know how to treat such patients.Methods:Using the retrospective investigation method, collecting the critically ill patients in ICU ward which all survived for more than24hours,in China Academy of traditional Chinese medicine Guanganmen hospital from Januaryl,2010-December31,2011. According to the diagnostic criteria for diarrhea, we divide two groups with and without diarrhea, and calculated the incidence of diarrhea. We collect the diarrhea patient’s general information, the first diagnosis, APACHE Ⅱ score within the first24hours, the time when diarrhea occurred, duration, the factors related to diarrhea, TCM syndrome, dejecta RT, GLU, ALB and the prognosis. Using the SPSS17.0to establishing the database and statistic.Result:1General information analysis:We collected322patients, the mean age is67.00±9.90years old. The average of APACHEⅡ score is21.14±5.69points. There were70patients of diarrhea, and the occurrence rate was21.7%.There were44males and26females, the mean age is73.23±11.23years old, The average of APACHEⅡ score is25.4±7.74points. There were252patients without diarrhea,132were male, and120were female, the mean age is65.26±8.77years old. The average of APACHEⅡ score is19.96±4.30points. The first time when diarrhea occurred is during2-15days in ICU, the average time is during5.37±2.58days. the duration of diarrhea is2-18days, the mean is5.51±2.95days. Among the patients with diarrhea,28cases died, the case fatality rate is40%.1.1The difference of gender distribution between the diarrhea and non diarrhea patients:diarrhea group M:F=44:26, without diarrhea group M:F=132:120.Two groups in gender composition have no statistical difference.(P>0.05).1.2The difference of age between the diarrhea and non diarrhea patients:diarrhea patients had a mean age of73.23±11.23years, non diarrhea is65.26±8.77years. And there is significant difference with the two groups.(P<0.05).1.3The difference of APACHE Ⅱ score between the two groups:the mean of diarrhea group is25.4±7.74, and19.96±4.30points in the group without diarrhea, Two groups in APACHE Ⅱ score have significant difference (P<0.05).1.4We divided the diarrhea patients into two groups at the22points of APACHE Ⅱ score, the incidence rate of the diarrhea between the two groups has statistics difference (P<0.05).1.5There is significant difference (P<0.05) between the diarrhea patients with surgical disease and with internal disease.1.6The analysis of relationship between the APACHE Ⅱ score and the time when diarrhea occurred and the duration:statistical analysis of APACHE Ⅱ score and the time diarrhea occurred have no relationship. And duration of diarrhea was positively related to the APACHE Ⅱ score.2The relationship between the related factors in critically ill patients with diarrhea, laboratory indexes and the fatality.2.1The correlation with the distribution of factors related to diarrhea:the diarrhea related to enteral nutrition is35cases, accounting for50%; and21cases related to astrointestinal motility drug use, accounted for30%; antibiotic associated diarrhea is6cases, accounting for8.57%; mechanical ventilation associated diarrhea is6cases, accounting for8.57%; intestinal infectious diarrhea is2cases, accounting for2.86%.2.2The relationship between the related factors in diarrhea and GLU, ALB:Using the5kinds of diarrhea types as the dependent variables, GLU and ALB as independent variables into the model, using the Logistic regression analysis, GLU and diarrhea types have no correlation. ALB and enteral nutrition related diarrhea have positive relationships. The diarrhea patients were divided into enteral nutrition related group and non-enteral nutrition related group. Two groups of albumin values have significant difference (P<0.05).2.3Factors related to diarrhea and mortality: Using the chi-square method, the relationship between the motility of gastrointestinal drug related diarrhea and enteral nutrition related diarrhea, antibiotic associated diarrhea, mechanical ventilation associated diarrhea, intestinal infectious diarrhea mortality, has significant difference (P<0.05).The other four have no differences in mortality.3TCM syndrome type distribution:the cold-heat jumble, mix to the voicing is41 cases, accounting for58.6%. The yang deficiency of spleen and kidney is16cases, accounting for22.8%.The spleen stomach damp heat syndrome is13cases, accounting for18.6%.Conclusion:This research show that diarrhea has become the main complications in ICU patients. The more serious the illness is, the greater the risk of diarrhea is. Compare with the patients with the surgical disease, the patients with internal disease are more susceptible to diarrhea. There is no relationship between the severity of the disease and the time diarrhea happened. However, the duration of the diarrhea is positively related to the severity of the disease.The rate of incidence of enteral nutrition related diarrhea was the highest. Patients with low value of albumin are susceptible to the diarrhea related to the enteral nutrition. The occurrence of diarrhea related to the gastrointestinal motility drug is higher than the literature reports. The occurrence of diarrhea related to the intestinal infectious is lower than the literature reports. The difference infers to the early intervention of traditional Chinese medicine when they had gastrointestinal dysfunction. Traditional Chinese medicine could improve the gastrointestinal dysfunction and cause objective diarrhea. The duration of diarrhea mostly short, and often stop when replace the traditional Chinese medicine. And the mortality rate in such patients is lower than the patients with diarrhea overall. The rate of incidence of antibiotic associated diarrhea and mechanical ventilation associated diarrhea are nearly the same with the literature.The most common type of TCM syndromes are cold-heat jumble and mix to voicing. And the second most common types are yang deficiency of spleen and kidney and damp heat of spleen and stomach. That is to say, the three types of syndromes could transfer to each other. To conclude, the most common type is cold-heat jumble and mix to voicing. So the treatment should include both reinforcing and discharge methods, and regulate the cold and heat. The tutor put forward the treatment of spicy open bitter drop and up clear drop turbidity, make up experience prescription "qi pi powder"."Qi pi powder" applied to clinical and obtained a certain curative effect. |
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