Clinical Research Of Therapeutic Effect Via Different Rude Rhubarb Administration Routes In Severe Acute Pancreatitis Combined With Intra-abdominal Hypertension

Objective:To investigate the treatment effects of injection rude rhubarb through nasogastric tube and nasojejunal tube in severe acute pancreatitis combined with intra-abdominal hypertension and compare the difference between the two groups in the influence of abdominal pressure and clinical indicators.With the aim of providing reference for clinical treatment.Methods:?1?Intervention methods:This paper selected 38 patients,who once lived in the digestive ICU of The First Affiliated Hospital of Nanchang University from March2019 to December 2019,with severe acute pancreatitis and intra-abdominal hypertension as the study objects.The patients were randomly divided into group A?The stomach tube group n=19 cases?and group B?the jejunum tube group n=19cases?.Group A patients were treated with intervention:routine treatment+gastric tube injection of 100 ml rhubarb solution,3 times a day.Meanwhile,Group B patients used intervention method:routine treatment+injection of 100 ml rhubarb solution through empty intestine,three times a day.All patients were given conventional treatments:fasting?gastrointestinal decompression?rehydration expansion?correct the disorder of water electrolyte and acid-base balance?antishock improves microcirculation?inhibition of acid by proton pump inhibitors?somatostatin inhibits pancreatic enzyme secretion?intravenous nutrition support?early enteral nutrition?prevention of intestinal flora disorders?antibiotics prevent infection?external application of the whole abdomen,Maintain important organ function:Ventilator assisted respiration,CRRT eliminates inflammatory mediators and improves renal function etc.This paper record the following observations of the two group's patients:the intra-abdominal pressure and stool frequency in day 1,2,3,5,7;the peripheral blood leukocyte count,the blood amylase,the SIRS score,the BISAP score,the APACHE II score,the ACS in day 1,7and the outcomes.?2?Statistical methods:The SPSS 25 statistical software was used to analysis experimental result.For the experimental data:The counting data expressed by rate and using chi-square test.The measurement data that meet with the normal distribution are described as mean±standard deviation?x±s?and using T-test or repeated measurement analysis of variance?Because of there are different observation indicators at different time points?.The non-normal distribution of measurement data,are represent by median?m?and quartile distance(P₂₅,p₇₅),using nonparametric test.The difference was statistically significant?P<0.05?.Results:?1?By monitoring the first,second,third,fifth and seventh day of the patient's abdominal pressure,the results showed that there was statistical difference in the rate of decrease of abdominal pressure in different time?F=51.414,P<0.001?and there was interaction between group A and group B?F=2.800,P=0.036?as well as statistical difference between the two groups?F=9.316,P=0.004?.On the 2nd,3rd,5th and 7th day,the decrease rate of abdominal pressure in group B was higher than that in group A and the difference was statistically significant?P<0.05?.There was statistical difference between the two groups in the value of abdominal pressure at different time points?F=35.855,P<0.001?;On the third day,there was a significant difference between group A?15.58±3.06?mmHg and group B?13.26±3.75?mmHg?t=-2.08,P=0.044?.On the fifth day,there was a significant difference between group A?13.84±3.58?mmHg and group B?11.58±3.12?mmHg?t=-2.079,P=0.045?.There was no significant difference at other time points?P>0.05?;But there was no interaction between group A and group B?F=1.605,P=0.196?and statistical difference between the two groups?F=3.327,P=0.077?.There was statistical difference in the number of stools at different time points between the two groups?F=28.211,P<0.001?and no interaction between the two groups?F=0.340,P=0.849?.There was statistical difference between the two groups?F=4.445,P=0.042?.?2?The blood amylase and peripheral leukocyte count of the two groups were compared on the first and seventh day after admission:The blood amylase of group A:The first day was?864.11±499.5?,the 7^th day was 52.5?34.25-70?,and that of group B The first day was?594.84±500.26?,the 7^th was57?41.5-73.5?.The difference between the two groups was statistically significant?P<0.05?,and there was no statistical difference between the two groups on the first day and the seventh day?P>0.05?.Peripheral blood leukocyte count:the first day of group A was?14.05±5.201?,and the 7^th day was 14.36?13-19.69?.The first day of group B was?15.95±8.229?and the 7^th was 11?9-15?.There was no significant difference between the two groups?P>0.05?.?3?Comparison of the scores of the patients in the first day and the seventh day:?1?About APACHEII scores:There was no statistical difference in APACHE II score of group A?P>0.05?.The first day was?13.16±4.18?and the 7^th day was?11.80±5.93?.However,there was statistical difference in APACHE II score of group B?P=0.021?.The first day was?11±3.786?and the 7^th day was?8.28±3.409?.There was no statistical difference between the two groups.?P>0.05?.?2?About SIRS scores:The SIRS of group A:The first day was 3?2-3?and the 7^th day was 3?2-4?.the SIRS of group B:The first day was 2?1.5-3?,the 7^th day was 2?2-3?;?3?About BISAP scores:The BISAP of group A:the first day was 3?2-4?,the 7^th day 3?2-4?.the BISAP of group B:the first day was 2?2-3?,the 7^th day was 2?2-3?.There was no statistical difference between the two groups?P>0.05?and the variation value from first day to seventh day.?4?The incidence of ACS in two groups:42.1%in group A and 10.5%in group B.So that there was a statistical difference?c²=4.886 P=0.027?.?5?There was a significant difference between the two groups in the length of stay in ICU between group A,which was 14?9-31?and group B,which was 9?6.75-12.25?.There was no significant difference in total length of stay between group A 26?19-56?and group B 22?21.5-27.5??P=0.198?;There were 17 cured patients and 2died in group A,19 cured patients in group B?c²=2.111 P=0.146?.Conclusion:?1?Both of the injection of rhubarb through nasogastric tube and nasojejunal tube can effectively defecate and reduce the abdominal pressure in severe acute pancreatitis combined with intra-abdominal hypertension.However,Injection of rhubarb through nasojejunal can reduce the abdominal pressure more quickly and effectively at an early date.?2?Injection of rhubarb through nasogastric tube and nasojejunal tube can reduce the level of serum amylase,but the decrease of WBC was not significant within one week.?3?The Rhubarb injection through nasojejunal tube can reduce APACHE II score,However,there was no significant difference in SIRS and BISAP scores;?4?Rhubarb injection through nasojejunal tube can reduce the incidence of ACS and the length of stay in ICU,but there is no difference in the total length of stay and prognosis.?5?The results of this study have clinical significance for the selection of rhubarb injection route in the early stage of severe acute pancreatitis.