The Study About Optimizing Management Plan Of Gastrointestinal Dysfunction In Critically Ill Patients

Objective:1. Study the related evaluation index influence of three different methods of preventive management on gastrointestinal dysfunction in critically ill patients’clinical, laboratory and the instruments.2. Compare the differences of three different methods of preventive management in critically ill patients with gastrointestinal dysfunction Intensive Care Unit (ICU) length of hospital stay, mortality rate and28days survival rate and ICU hospitalization cost.Method:Collecting62Patients met the diagnostic criteria, inclusion criteria and exclusion criteria from Guangzhou Traditional Medicine Hospital’ comprehensive ICU and Guangdong General Hospital, East district ICU. According to the random number table method, divided the Patients into groupl, groups2and group3. Remove2shedding cases, groupl,18cases, group2,25cases, group3,17cases finally into the research. Patients of3groups were implementing prevention-based management programs, including basic treatment, gastrointestinal function and Enteral Nutrition (EN) tolerance assessment and evaluation of the reasonableness of the heat supply. Scenario1:energy supply:giving the target amount of calories at the beginning, at the first three24h EN calories respectively does not exceed25%,50%,75%of the target amount of calories, less heat Parenteral nutrition (PN) supplement, Ie gastrointestinal function by using the EN+PN way for energy, no gastrointestinal function by using the PN way for energy;timely adjustments EN, PN volume and the proportion based on Circular assessment of gastrointestinal function and reasonable heat supply;give the1st or the2nd Chinese medicine. Scenario2:energy supply methods:Patients have gastrointestinal function supply energy by EN early, three days does not meet the60%of target calories with PN supplement;Other aspects are the same as Scenario1. Scenario3:the same as Scenario2, but does not tuse Chinese medicine. Three groups were treated for7days. Observed differences in the three groups of related evaluation of clinical, laboratory and ICU length of stay, mortality, survival, and28days survival and hospitalization expenses of ICU after treatment.Results:Using SPSS17statistical software statistical conclusions are as follows:1.The three groups have no statistical significance (P>0.05) in gender (P=0.1436), age (P=0.4448), and the illness severity (P=0.4455, P=0.8364).2. The three group’s Integral rate of increase has no obvious change before and after the end of the course, has no statistically significant difference (P=0.1099, P=0.8203, P=0.4922, P>0.05). the group1, group2can significantly reduce patients gastrointestinal integral, has statistically significant difference (P=0.0090, P=0.0000, P<0.05). the group3gastrointestinal integral has no obvious change before and after the end of the course, has no statistically significant difference (P=0.0547, P>0.05)3. The Intra abdominal pressure (IAP) of groupl, group2decreased obviously after treatment, has statistically significant difference(P=0.0043, P=0.0000, P<0.05). The IAP of group3has no obvious change before and after the end of the course, has no statistically significant difference (P=0.0545, P>0.05).4. After treatment, the three groups’comparison of target standard the rate of EN reach target heat quantity has no statistically significant difference (P=0.1326, P>0.05).5. The time. for group2、group3to get the goal of heat significantly less than groupl, has statistically significant difference (P=0.0338, P=0.0007, P<0.05).The times for Group2and group3to get the goal of heat are same, has no statistically significant difference (P=0.3759, P>0.05)6. The three groups’critically ill patients in ICU days compared, has no statistically significant difference (P=0.8003, P>0.05)7. Group1and group2, group2and group3,28days survival rate comparison, has no statistically significant difference (P=0.0579, P=0.5509, P>0.05); group1and group3,28days survival rate comparison, the difference has statistically significant (P=0.0247, P<0.05), the reason may Multiple organ dysfunction syndrome (MODS) incidence of groupl was obviously higher than that of group3.8. Group1’s ICU mortality was significantly higher than group2and group3, the difference has statistically significant (P=0.0402, P=0.0324, P<0.05); Group2and group3, ICU mortality compared, has no statistically significant (P=0.7002, P>0.05).9. The comparison of the three groups’average daily cost in ICU, has no statistically significant (P=0.0524, P>0.05)Conclusion:1. Three groups’critically ill patients has no obvious difference in gender, age, disease severity.2. The three group have no effect on patient’s Integral rate of increase before and after treat. But the scheme1, scheme2can significantly reduce patients gastrointestinal integral, Improvement patients gastrointestinal function, There is significant difference before and after treatment, Scheme3is not.3. Scheme1, scheme2can obviously reduce Critically ill patients bladder pressure, but Scheme3is not.4. the three groups’comparison of target standard the rate of EN reach target heat quantity, there were no significant differences.5. The time for group2、group3to get the goal of heat significantly less than groupl, The times for Group2and group3to get the goal of heat are same. the reason may be that groupl control EN calories of patients, in the first3days, To Causes the EN of target heat for an extended period of time.6. The three group patients with severe ICU stay days there is no obvious difference between.7. The comparison of Groupl and2about28days survival rate was no significant difference; The comparison of Group2and3about28days survival rate was no significant difference; Groupl’s28days survival rate was significantly lower than Group3, the reason may MODS incidence of groupl was obviously higher than that of group3, the more organ damage, the higher the mortality. 8. Group1’s ICU mortality is increased significantly than the group2and group3;group2and group3, in the ICU mortality compared to no significant difference. Group1ICU mortality rate is increased significantly than Group3may be due to Group1MODS prevalence was higher in group3. And group1and group2prevalence of MODS has no significant difference, Indicate that group2is better than groupl in reducing the ICU mortality rate of patients with severe.9.three group of average hospitalization expenses without difference.