| Gastrointestinal failure is one of the common disorders in critical patients,its main manifestations are acute gastric mucosal lesions and toxic enteroparalysis, it was known as the "trigger factors" of MODS. The effective prevent and cure of gastrointestinal failure is the main methods to prevent the development of MODS, and it is also the key point of reducing the death rate of critical patients. At present, Western medicine in this pathologic process has no effective prevention and treatment methods. Chinese medicine in the prevention and treatment of this disease has become increasingly active, but most remains in the observation stage of its mechanism, and it is also lack the systematic research in mechanism of action and link. After years of clinical practice study, my tutor believed that the Chinese pathogenesis of the critical patients in gastrointestinal failure was poison and evil invasion while it was weak, gastrointestinal blood stasis, leading qi-movement disturbance and disharmony movements to lead to stomach Gas lose and dissociation of yin and yang. Under the guidance of the theory of Chinese medicine, my tutor used the way that combined the differential diagnosis of diseases and differentiation of symptoms and signs and to begin with purging heat fu-unblocking therapy, promoting blood flow nourishing yin, and finally he work out the CHANGWEISHU, which was used to prevent and cure the gastrointestinal failure of critical patients, ease of critical illness, lower its mortality rate.Objective: To study the CHANGWEISHU on the function of preventing and curing the gastrointestinal failure of critical patients, and to observe its impact on soluble vascular cell adhesion molecule-1 (sVCAM-1), interleukin-6 (IL-6) and the endotoxin, so as to investigate the action mechanism of CHANGWEISHU on preventing and curing the gastrointestinal failure of critical patients.Methods:The cases of 48 observation cases were all from our emergency room ICU critical patients who lived there at the time of 2006 in March—2007 June. According to hospital sequence code in accordance with random number table, the cases were randomly divided into two groups: the prevention and cure group (CHANGWEISHU) 24 cases and the control group (Motilium suspension) 24 cases. After the process of statistics, two groups in gender, age, protopathy, severity of illness and other aspects of the statistical differences were not significant (P>0.05), so it had comparability (see Schedule 1,2,3,4).The prevention and cure group was to give CHANGWEISHU decoction 150ml, nasal feeding at morning and afternoon. (The drugs are Radixet rhizoma rhei 9g, Dandelion 20g,Ophiopogonis tuber 15g,Pericarpium citri reticulatae viride 15g,Angelica 15g, Erythro- white peony root 12g, Szechwan lovage rhizome 9g, Agrimony 20g,Coptis 6g,QingXia 6g,Snakegourd fruit 15g,Sanguisorba 20g,PORIA from Yunnan of China 20g. they were all thick fried by our hospital manufacturing laboratory).The control group was to give Motilium suspension 20ml ,nasal feeding every four hours once. Both groups were observed five days. Other measures, such as anti-infection treatment, the etilogical treatment, organ function support, maintain its internal environment stable, nutritional support, symptomatic treatment, and other measures were all the same. To observe the Gastrointestinal failure and the death condition, the score changes of APACHEⅡbefore and after treatment and the impact on serum sVCAM-1, IL-6 and endotoxin in two groups.Results: 1. Comparison of gastrointestinal failure rate in two groups (see Figure 1, Table 5): In the prevention and cure group, there were three cases of acute gastric mucosal lesions (12.5%), two cases of intestinal paralysis toxicity (8.33%), two simultaneous two cases (8.33%), including one case of death (4.17%). The total incidence rate was 29.17 percent. In the control group, there were five cases of acute gastric mucosal lesions (20.83%),seven cases of intestinal paralysis toxicity (29.17 %), two simultaneous four cases (16.67%), there cases of death (12.5%).The total incidence rate was 29.17 percent, the chi-square test showed p<0.01, there was significant difference between the two groups statistically. It showed that the prevention and cure group would effectively prevent the occurrence of critical patients with gastrointestinal failure; the effect was significantly better than the control group. 2. Comparison of APACHEⅡscore changes in two groups(see Figure 2, Table 6): in the prevention and cure group, APACHEⅡscores before and after treatment were 16.3±2.4 points, 8.3±3.1 points, the t-test showed p<0.01, there was significant statistical difference; in the control group, APACHEⅡscores before and after treatment were 16.08±2.5 points, 11.1±4.8 points, the t-test showed p<0.01, there was significant statistical difference;compared the two groups after treatment by the t-test, it showed p<0.05, there was significant statistical difference. Two cases of illness after treatment than before treatment severity lessened, but to improve prevention and cure group of patients with critical illness efficacy was significantly better than the control group. 3. Comparison of serum IL-6 changes in two groups(see Figure 3, Table 7): in the prevention and cure group, serum IL-6 levels before and after treatment were 314.4±39.0,160.3±45.8, the t-test showed p<0.01, there was significant statistical difference; in the control group, serum IL-6 levels before and after treatment were 313.5±37.4,242.6±46.6,the t-test showed p<0.01, there was significant statistical difference; compared the two groups after treatment by the t-test, it showed p<0.01, there was significant statistical difference. After treatment, serum IL-6 levels of two groups were all lower than before, but the prevention and cure group inhibitory effect of serum IL-6 was significantly better than the control group. 4.Comparison of serum sVCAM-1 changes in two groups(see Figure 4, Table 8): in the prevention and cure group, serum sVCAM-1 levels before and after treatment were 23.74±2.15,16.53±2.46, the t-test showed p<0.01, there was significant statistical difference; in the control group, serum sVCAM-1levels before and after treatment were 23.72±2.30,18.93±2.23,the t-test showed p<0.01, there was significant statistical difference; compared the two groups after treatment by the t-test, it showed p<0.01, there was significant statistical difference. After treatment, serum sVCAM-1 levels of two groups were all lower than before, but the prevention and cure group inhibitory effect of Serum sVCAM-1 was significantly better than the control group. 5. Comparison of serum endotoxin changes in two groups(see Figure 5, Table 9):in the prevention and cure group, serum endotoxin levels before and after treatment were 1.000±0.115,0.68923±0.119,the t-test showed p <0.01, there was significant statistical difference; in the control group, serum endotoxin levels before and after treatment were 0.999±0.121,0.964±0.108,the t-test showed p>0.05, there was no significant statistical difference; compared the two groups after treatment by the t-test, it showed p<0.01, there was significant statistical difference. After treatment, serum endotoxin levels of the prevention and cure group was lower than before, the prevention and cure group can effectively remove the endotoxin, their efficacy was significantly better than the control group.Conclusion: This study showed that CHANGWEISHU can effectively prevent gastrointestinal failure in critical patients, relive critical patient's condition. Its mechanism of action may relate with the reason that CHANGWEISHU can effectively inhibit the serum sVCAM-1 and IL-6 levels increased and remove the endotoxin. From the perspective of clinical curative effect, the finding showed that poison and evil was intrinsic and gastrointestinal blood stasis were the key to pathogenesis of the gastrointestinal failure. The way that purging heat fu-unblocking therapy, promoting blood flow nourishing yin can effectively prevent and cure the gastrointestinal failure of critical patients, it provided new methods and ideas for clinical prevention and cure this disease. |
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