The Syndrome Factor And The Syndrome Distribution Rule And The Clinical Observation Of TCM Treatment On The Critical Illness Patients With Gastrointestinal Dysfunction

Background:Gastrointestine (GI), the organ containing, digesting and absorbing nurture, the hugest bacteria species inside the body, one of the most active metabolic organs, whose mucosal barrier has effect on micro-ecological environment balance and keeping from bacteria and endotoxin translocation, plays an important role in digestive system. Owing to ischemia and anoxia, mucosal barrier of GI damage and micro-ecological environment unbalance is likely to be induced with secondary translocation of bacteria and endotoxin imperiling the normality of organs and even the life once GI dysfunction takes place. GI dysfunction is the essential ingredient of multiple organ dysfunction syndrome (MODS) and one of the elements inducing and aggravating MODS. MODS includes GI dysfunction with the occurrence of the former could induce and/or aggravate the latter. Nowadays the treatment of MODS and GI dysfunction mainly contains as such:the supportive treatment of sustaining life organs(respiratory support, circulation support and renal replacement, e.g.), intensively monitoring intestine function such as intestine mucosal barrier and the endotoxin level, improving blood supply of intestine mucosal by the use of vasoactive agents, lessening the excessive and maladjusted proliferation of bacteria inside the enteric cavity along with antioxidant by selective digestive decontamination(SDD), early intestine resuscitation to restore enteral nutrition. Medication contains gastrointestinal prokinetic drug, H2receptor blockers, proton-pump inhibitor (PPI), gastric mucosa protective agent and microecologics, etc. In recent years traditional Chinese medicine(TCM) has played an important role in treating MODS and GI dysfunction. Xiyuan Hospital has formulated diagnosis and treat routine(abdominal distension, haematemesis and melaena, etc.) and proceeded with this research to explore the advancement of TCM and improve the veracity of the differentiation for further clinical efficacy. Objective:To study the differentiation elements and the type of syndrome’s distributing pattern of TCM and clinical efficacy of MODS and GI dysfunction by TCM.Methods:To study cases selected according to the diagnosis, inclusion and exclusion criteria by two-step strategy. The first step is to bring in138patients by retrospective study method, then find out the differentiation elements and the distributing pattern of the syndrome of MODS and GI dysfunction and further more dominant syndrome pattern with the determination of the differentiation elements and the diagnosis of the syndrome according to Calculating Differentiation of common symptoms. The second step is to bring in30patients into2groups, the control group and the treatment group for15respectively by randomization and record the general data, main causes of being checked in ICU and main past history, etc. To observe and record WBC calculation, borborygmus, occult blood(OB) test, abdominal perimeter, intra-abdominal pressure(IAP), gastrointestinal dysfunction score and APACHE II Score before the treatment and the4th day,7th day after the treatment. To evaluate the clinical and TCM syndrome efficacy after the observation period with analyzing the data with statistics.Results:To introduce by two steps.1st step:To patients of MODS and GI dysfunction, the elements of disease nature tend to be Qi Deficiency>Blood Deficiency> Phlegm Retention>Heat Excessiveness>Yang Deficiency>Yin Deficiency>_Blood Stasis>Qi Stagnation and the elements of disease location be spleen>stomach>heart and mind>renal>lung> liver. The disease nature tends to be Deficiency Syndrome> Excess Syndrome>Intermingled Syndrome of Deficiency and Excessiveness. The differentiation pattern distribution:Deficiency Syndrome tends to be Syndrome of Deficiency of Qi and blood of Spleen-stomach> Deficiency of Heart-spleen> Prostration Syndrome of Heart Yang, Intermingled Syndrome of Deficiency and Excessiveness be Syndrome of Spleen Deficiency and Phlegm Obstruction> Syndrome of Heat Excessiveness and Deficiency of Qi and Yin> Syndrome of Yin Deficiency and Blood Stagnation, Excess Syndrome be Syndrome of Mind Being Disturbed by Phlegm and Heat> Syndrome of excessive lung heat> Syndrome of accumulation of damp-heat and disorder of liver-spleen.2nd step:(1)To contrast the difference of temperature, heart rate, WBC calculation, APACHE II score, OB test, IAP and GI score between the treatment group and the control group on the4th day that there’s no statistical difference(P>0.05).To contrast the difference of heart rate, WBC calculation, APACHE II score, borborygmus, abdominal perimeter and GI score that there’s statistical difference(P<0.05), while that of temperature and OB test without statistical difference(P>0.05).(2) For the treatment group, to contrast the difference of temperature, heart rate, WBC calculation, APACHE II score, borborygmus, abdominal perimeter, IAP and GI score between the4th/7th day after the treatment and prior to it that there’s statistical difference(P<0.05or0.01) and the difference of OB test between the4th day after the treatment and prior to it that there’s no statistical difference(P>0.05), while that between the7th day and prior to it with statistical difference(P<0.05).(3) For the control group, to contrast the difference of temperature, APACHE II score, borborygmus, abdominal perimeter, IAP and GI score between the4th/7th day after the treatment and prior to it that there’s statistical difference(P<0.05or0.01) and the difference of heart rate and WBC calculation between the4th day after the treatment and prior to it that there’s no statistical difference(P>0.05), while that between the7th day and prior to it with statistical difference(P<0.05). However, to contrast that the difference of OB test between the4th/7th day respectively and prior to it without statistical difference(P>0.05).Conclusions:1. To learn that the elements of disease nature of MODS and GI dysfunction are Qi Deficiency, Blood Deficiency, Phlegm Retention, Heat Excessiveness, Yang Deficiency, Yin Deficiency, Blood Stasis and Qi Stagnation, while the elements of disease location are spleen, stomach, heart and mind, renal, lung and liver. And to learn that the syndrome distribution pattern conclude Syndrome of Deficiency of Qi and Blood of Spleen-stomach, Syndrome of Deficiency of Heart-spleen, Prostration Syndrome of Heart Yang, Syndrome of Deficiency of Spleen-renal Yang and Syndrome of Spleen Deficiency and Phlegm Obstruction.2.To learn that Huangqi-danggui Jianzhong Decoction has definite effects on MODS and GI dysfunction.