Clinical Research On Purgative Therapy For Patients With Mods

Objective: Multiple organ dysfunction syndrome (MODS), which is characterized asurgent onset, critical condition and low survival rate, has been focused on.Gastrointestinal failure, one symptom of MODS, is considered as a “trigger” of MODSworsening. Intestinal tract is the biggest internal “endotoxin storage” and “bacteriastorage”. When patients are exposed to stress such as severe trauma, major surgery,shock and ischemia-reperfusion, the membrane permeability of intestinal mucous willincrease. As a result the pathogens in intestinal tract will translocate to blood, whichresults in MODS worsening. The symptoms of MODS such as abdominal distension,vomiting, no exhaust and defecation, weakening or disappearing of borborygmus, aresimilar to YangMingFuShiZheng in Treatise on Febrile Diseases, which leads to theapplication of “Purgative Therapy” in the treatment of MODS. In the present study, wedetected serum levels of DAO (diamine oxidase), D-lactic acid, IL-6and IL-10andcompared Acute physiology and chronic health scoring (APACHE II scoring), MODSscoring, parameters of organs function and28-day death rate. Our aim was toinvestigate the effects of “Purgative Therapy” on intestinal mucosal barrier, SIRS, vitalorgans function and prognosis in patients with MODS.Methods: A total of51patients were enrolled from the emergency room and emergencyintensive care unit (EICU) of First Affiliated Hospital of Dalian Medical University.These patients were randomized into treatment group (n=27) and control group (n=24)according to double-blind. In the treatment group, patients were given100ml ofDachengqi decoction via oral administration, nasogastric intubation or clyster,1-2timesper day, for3-5days, based on comprehensive modern medical therapy. The daily doseof Dachengqi decoction was adjusted according to the condition of defecation. In thecontrol group, patients were given enema using100ml of normal saline based oncomprehensive modern medical therapy. At baseline and3or5days after the abovetreatments we detected serum levels of DAO, D-lactic acid, IL-6,IL-10, CK, CK-MB, ALT, AST, CRE, Urea, observed exhaust and defecation time, borborygmus andabdominal distention, evaluated APACHE II and MODS scorings, and recorded deathswithin28days.Results: Compared to control group, at third or fifth days patients in the treatmentgroup showed lower serum levels of DAO, D-lactic acid, IL-6, CK, CK-MB andrecovery time of intestinal dynamics (P<0.05); at fifth day patients in the treatmentgroup showed lower serum level of IL-10and MODS scoring (P<0.05). At third or fifthdays patients in the treatment and control groups had similar APACHE II scoring, andserum level of ALT, AST, CRE and Urea (P>0.05). Patients in the treatment group had alower28-day death rate when compared to control group, but this difference did notreach statistical significance (P>0.05).Conclusion: Purgative therapy for patients with MODS promotes intestinal mucosalbarrier, prevents intestinal endotoxin and bacteria translocation, and alleviate SIRS.These effects may contribute to improve vital organs function. The28-day death rate isdecreased, but this decrease did not reach statistical significance (P>0.05). Further studyof large sample size and multiple centers is to determine the effect of Purgative therapyon prognosis of patients with MODS. Purgative therapy combined with comprehensivemodern medical therapy provides new therapeutic strategy for the treatment of MODS.