Clinical Study On The Gastrointestinal Protection Of Bundle Nursing On Critically Ill Patients

ObjectivesTo explore the effects of gastrointestinal bundle nursing and routine nursing on the protection of gastrointestinal function on critically ill patients,observe its impact on D-lactate,diamine oxidase?DAO?,APACHE II score,gastrointestinal dysfunction?GID?score,intra-abdominal pressure?IAP?,MODS incidence.Compare and analyze therapeutic effects and economic benefit between the two groups,in order to seek a safe,effective,economic and feasible gastrointestinal bundle nursing program which is easy to operate.MethodsThis study was a randomized controlled clinical trial,chose ICU patients who were hospitalized in the Seventh people's hospital of Shenzhen during 2016 January to 2017 March as screening population,determined the research object according to the inclusion and exclusion criteria,and the subjects were randomly divided into experiment group and control group by simple number table method according to the admission sequence.Both groups accepted basic treatment,the experiment group was given gastrointestinal bundle nursing in the early period?within 6h?,that is,set up a cluster group,cleaned the gastrointestinal tract by?nasal feeding combined with enema of rhubarb?once a day,improved gastrointestinal motility by?acupoint massage+music therapy?twice a day,and monitored IAP and gastrointestinal function once a day;the control group was given gastrointestinal routine nursing;the intervention lasted for 7days.General information of all patients was recorded,and we compared,analyzed D-lactate ? DAO concentration before intervention,on the 1^st day,4^th day and 7^th day;APACHE ? score,GID score,IAP and incidence of gastric retention before and on the 7^st day after intervention;incidence of MODS,the length of stay and cost in ICU of two groups.The information was collected and statistically analyzed.Measurement data was described by mean add or subtract standard deviation????�SD?;compared by two independent sample t-test or repeated measuresvariance analysis;Enumeration data was described by frequency?percentage?[n?%?],compared by chi square test,continuity correction or Fisher exact probability between the groups.Results1.General Information The study included 60 cases,3 cases transferred out in experiment group,2 cases withdrew midway in control group,therefore there were 55 effective cases,27 in experiment group and 28 in control group in the statistical analysis finally.Comparisons of general information?demographic,disease-related information?of two groups showed no statistical difference?P>0.05?.2.Laboratory index2.1 D-lactate Repeated measures analysis of variance showed that there was statistical difference of D-lactate in intervention,time,intervention and time interaction?F=19.515?20.057?6.644,P<0.05?;D-lactate was compared at different time points:there was statistical difference between experiment group and control group on the 4th day and 7th day?t=-2.454?-6.819,P<0.05?,before intervention and on the 1stday showed no statistical significance?t=-0.154?0.056,P>0.05?.2.2 DAO Repeated measures analysis of variance showed that there was statistical difference of DAO in intervention,time,intervention and time interaction?F=17.185?10.152?7.388,P<0.05?;DAO was compared at different time points:there was statistical difference between experiment group and control group on the 4th day and 7th day?t=-2.429?-9.012,P<0.05?,before intervention and on the 1st day showed no statistical significance?t=-1.240?-1.210,P>0.05?.3.Clinical prognostic indicator3.1 APACHE II score Comparison between groups:there was no statistical difference before intervention?t=0.773,P>0.05?,experiment group and control group both showed statistical difference after intervention?t=-5.282,P < 0.05?;Comparison within groups:there was statistical difference both in experiment group and control group before and after intervention?t=-13.455?8.043,P<0.05?.3.2 GID score Comparison between groups:there was no statistical difference before intervention?t=1.950,P > 0.05?,experiment group and control group showed statistical difference after intervention?t=4.280,P<0.05?;Comparison within groups:there was statistical difference in experiment group before and after intervention?t=5.750,P<0.05?,but no in control group?t=0.000,P>0.05?.3.3 IAP Comparison between groups:there was no statistical difference before intervention?t=-0.091,P > 0.05?,experiment group and control group showed statistical difference after intervention?t=12.082,P < 0.05?;Comparison within groups:there was statistical difference in experiment group before and after intervention?t=12.433,P<0.05?,but no in control group?t=-1.411,P>0.05?.3.4 Incidence of gastric retention Comparison between groups:there was no statistical difference before intervention??2=0.164,P > 0.05?,there showed statistical difference after intervention??2=4.476,P<0.05?;Comparison within groups:there was statistical difference in experiment group before and after intervention??2=4.688,P<0.05?,but no in control group??2=0.113,P>0.05?.3.5 Incidence of MODS There was statistical difference between experiment group and control group after intervention??2=5.750,P<0.05?.4.Economic benefits indicator There was statistical difference of the length of stay and cost in ICU between experiment group and control group after intervention?t=-5.791?-6.808,P<0.05?.Conclusions1.Gastrointestinal bundle nursing program had a good protective effect on gastrointestinal function of critically ill patients,which could obviously reduce D-lactate and DAO concentration,improve the gastrointestinal function,and reduce the occurrence of MODS,improve the prognosis of patients,save medical cost,achieve the expected social and economic benefits.2.Gastrointestinal bundle nursing program has the advantages of good security,strong operability,economic feasibility,high practical value and good development prospect,provide a new theoretical basis for gastrointestinal protection of critically ill patients.