| ObjectiveGastrointestinal(GI)dysfunction plays a critical role in the prognosis of critically ill patients.Previous studies showed Rhubarb,a traditional Chinese herb,can protect the intestinal barrier function,prevent intestinal bacterial translocation,promote GI peristalsis,but the clinical studies are less.The aim of this study was to evaluate the effects of Rhubarb on GI dysfunction in critically ill patients.MethodsFrom June 2015 to May 2017,patients in intensive care unit(ICU)were screened according to the inclusion and exclusion criteria.A total of 368 critically ill patients were eventually enrolled in this retrospective cohort study.Patients were divided into two groups according to the exposure factors(whether the patients received Rhubarb treatment): the Rhubarb group and the usual treatment group.For the rhubarb group,all patients received conventional medication plus rhubarb therapy.For the usual treatment group,all patients were treated with only conventional medication.Conventional drug therapy includes primary disease treatment,antiinflammatory,antiinfection,nutritional support,prokinetic agents treatment,and symptomatic treatment.Clinical data were collected within the first 24 hours of intensive care unit admission and 7 days after treatment.The curative effects of the two groups were compared.Propensity score matching(PSM)was conducted to reduce confounding bias between the groups.ResultsThe eligible patients were divided into Rhubarb group(n=219,59.51%)and usual treatment group(n=149,40.49%).Baseline characteristics:Compared with the usual treatment group,the degree of abdominal distention and the acute gastrointestinal injury(AGI)grade were higher in the Rhubarb group(Severe abdominal distention: 43.84% vs 4.70%,AGI ?: 43.84% vs 4.70%,P<0.05.The Sequential Organ Failure Assessment score(SOFA),Acute Physiology and Chronic Health Evaluation? score(APACHE?)in the Rhubarb group were lower than those in the usual treatment group(SOFA: 4.84±3.09 vs 6.44±3.45,APACHE?: 12.88±6.14 vs 14.98±5.77,P<0.05).The use of Enemia Glycerini,Clostridium Butyricum Tablets,prokinetic agents were less frequent in the Rhubarb group(Enemia Glycerini: 54.79% vs 77.18%,Clostridium Butyricum Tablets: 35.16% vs 48.32%,prokinetic agents : 17.35% vs 32.21%,P<0.05).With PSM,68 pairs of patients were successfully matched.There was no significant difference in baseline characteristics between the two groups after matching.The primary outcome of this study: Before PSM,the remission rate of feeding intolerance in Rhubarb group and usual treatment group were 59.82% and 39.60%,respectively.After PSM,the remission rate of feeding intolerance in Rhubarb group and usual treatment group were 77.94% and 30.88%,respectively.The remission rate of feeding intolerance of rhubarb group was significantly higher than that of usual treatment group(P<0.05).The secondary outcome of this study: Compared with the usual treatment group,the Rhubarb group had higher rate of improvement of AGI grade and bowel sound,shorter stay in ICU,lower level of SOFA,APACHE?,CRP and endotoxin before and after propensity score matching(Before PSM: Improvement of AGI grade: 75.34% vs 29.53%,Improvement of bowel sound: 90.41% vs 72.48%,Days in ICU: 12.00(9.00,18.00)vs 14.00(9.50,21.00),SOFA: 4.23±3.57 vs 5.84±3.69,APACHE ? : 11.92±6.55 vs 14.11±6.30,CRP: 23.21(9.00,52.97)vs 47.08(24.00,92.86),Endotoxin: 0.06(0.04,0.10)vs 0.07(0.05,0.11).After PSM: Improvement of AGI grade: 76.47% vs 33.82%,Improvement of bowel sound: 91.18% vs 64.71%,Days in ICU: 12.00(9.00,18.50)vs 13.00(9.50,20.50),SOFA:4.54±3.61 vs 5.63±3.79,APACHE?:12.56±6.03 vs 13.74±6.00,CRP: 25.39(12.03,67.71)vs 53.48(28.19,100.25),Endotoxin: 0.06(0.04,0.10)vs 0.07(0.05,0.10),P<0.05).There was no significant difference for the 28 day mortality when comparing the two groups before and after PSM(Before PSM: 22.37% vs 22.15%.After PSM: 30.88% vs 23.53%,P>0.05).No serious adverse effects were found in 2 groups.ConclusionThe Rhubarb might significantly enhance enteral nutrition tolerance and relieve gastrointestinal dysfunction in critically ill patients without serious adverse reactions.It provides proof for the treatment of gastrointestinal dysfunction with Rhubarb during clinical practice. |
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