| There is a high incidence of intestinal motility disturbance after severe trauma and it may restrict the application of enteral nutrition, lead to the disturbance of intestinal flora, aggravate the body’s inflammatory response, and even to result in systemic inflammatory response syndrome(SIRS) or multiple organ dysfunction syndrome(MODS), so there will be great significance to prevent and cure the intestinal motility disturbance in improving the patients’ clinical progonosis after severe trauma. However, the complexity of intestinal dynamic obstacle mechanism, the surgery after trauma and treatment with drugs can further inhibit intestinal motility, and the prevention and treatment of intestinal dismotulity after trauma has been always a problem in clinical work. In recent years, clinical studies have shown that, probiotics applied in patients with trauma can not only regulate intestinal flora imbalance, promote immune function and improve the imbalance of the intestinal flora, but also can improve the intestinal motility, but the effect of promoting intestinal motility is weak; traditional Chinese medicine dachengqi decoction(DCQT) can improve the mucosal barrier and the motility of intestine, but the power of its purgative activity is intensive. It can cause diarrhea without end and then restrict its application in trauma patients. Our previous animal experiments found that DCQT combined with probiotics can improve the intestinal mucosal and intestinal motility of mice after severe head injury, and the effects were better than the effects when the drugs used respectively. But it need to be tested whether the combinational therapy has the same effect on intesinal motility disturbance in clinical patients after severe trauma. This study aims to observe the effects of DCQT combined with probiotics on intestinal motility and clinical outcomes in patients with severe trauma, and then to provide valuable solutions for clinical treatment of the trauma patients.Methods: After approved by the hospital ethics committee, according to the randomnumber table, 104 cases of severe trauma patients were randomly assigned into the 4 groups, ie. the control group, the probiotic group, the DCQT group and the combined group, and each group included 26 patients. All the patients of the 4 groups were supported with enteral nutrition by gastric tube within 24~72h after trauma, and the patients should also be in hemodynamic stability and with a gastric retention amount<200ml. The control group was treated with enteral nutrition only; the probiotic group was applied with probiotics: 4 pills/time, 2 times/d(the total bacteria content no less than 1×108 CFU/d), lasting 14 days; the DCQT group was applied with DCQT 50 ml/time, 2 times/d with the duration of 3~5 days. The application of DCQT should be immediately stopped if liquid stools per day appeared or the defecation frecuency was more than 3 times or defecation occult blood test was positive. Patients in the combined group took DCQT 2 hours after taking probiotics with the same methods as above. The rates of abdominal distention, diarrhea, constipation, reflux, vomiting, stomach retention and hemorrhage of digestive tract among the 4 groups were observed; the time of first defecation and targeted nutritional goals were recorded; APACHEⅡscores, SIRS scores, incidence of respiratory tract, urinary tract, bloodstream and wound infection and the length of ICU stay were compared. Blood samples were collected in the morning at 0, 4, 8, 15 days to detect serum MTL, VIP, DAO, D-Lac levels, and contents of albumin, total protein, retinol binding protein, hemoglobin, albumin, white blood cell counts, C-reactive protein and procalcitonin.Results: 7 patients were eliminated because the length of hospital stay was less than 7 days, so there were 97 cases included finally. The numbers of the cases in the control group, the probiotic group, the DCQT group and the combined group were 23, 25, 24, 25 respectively. There were no dramatic differences in general condition, body condition and basic treatments of patients among the 4 groups after admission(P>0.05).1. Effects of Dachengqi Decoction combined with probiotics on intestinal motility disturbance in patients with severe trauma1.1 Contents of serum of MTL and VIP variablesAfter trauma, the serum MTL level among the 4 groups increased firstly, and then decreased, but the combined group showed a stable trend. At day 4, the contents of the combined group and the DCQT group were higher than the control group, the differences were statistically significant(P<0.05); at day 8, the content in DCQT group was higher than it in the other 3 groups(P<0.05); at day 15, the contents of the three groups were significantly higher than that of the control group, and the differences were statistically significant(P<0.05).At day 4, the serum VIP contents of the combined group and the probiotic group were respectively dramatically lower than it in the control group, the differences were statistically significant(P<0.05); at day 8, the content of combined group was also lower than the control group and DCQT group(P<0.05); at day 15, the three groups’ contents were significantly lower than that in the control group, the differences were statistically significant(P<0.05).1.2 Contents of serum of DAO and D-Lac variablesAfter trauma, the serum DAO and D-Lac levels among the 4 groups increased firstly, and then decreased. The DAO levels of the combined group and probiotic group at day 8, 15 were lower than the control group dramatically(P<0.05), and at the same time, at day 15, the combined group level was also significantly lower than DCQT group(P<0.05). At day 8, the contents of D-Lac of the probiotic group and the combined group were lower than the control group and DCQT group(P<0.05).1.3 Effects on the gastrointestinal adverse reactions and enteral nutritionThe incidence of abdominal distention, gastric retention, diarrhea, reflux and vomiting and the time to targeted nutrition goals of the patients in the 4 groups were not statistically significant(P>0.05); In the comparision of the rates of constipation, the combined group and the DCQT group showed significantly lower level than it in the control group(0 vs. 43%, P=0.000; 43% vs. 43%, P=0.006). In terms of reducing the incidence of gastrointestinal bleeding, the combined group showed an apperant advantage compared with the control group(0 vs. 22%, P=0.02). In the comparison of the first defecation time, the DCQT group showed the shortest time, and the combined group was shorter, the difference in the four groups was statistically significant(P=0.001).in patients with severe trauma 2. Effects of Dachengqi Decoction combined with probiotics on clinical prognosis2.1 Effects on nutrition indicatorsThe levels of albumin, total protein, hemoglobin of patients among the 4 groups didn’t show any difference(P>0.05); The differences in the level of albumin at day 0 and 4 were not significant(P>0.05), at day 8 and 15, the combined group showed higher level of albumin than that in the other 3 groups(P<0.05); There were no obvious differences of retinol binding protein in the 4 groups at day 0, 4, 8(P>0.05), whereas, the level of retinol binding protein in combined group was higher than it in the control group and the DCQT group at day 15(P<0.05).2.2 Effects on inflammation indicatorsThe differences of the concentrations of CRP and WBC in the 4 groups at 0, 4, 8 and 15 days were not significant; the differences of the concentration of PCT in the 4 groups were not significant at day 0 and 4(P>0.05), but at day 8, the concentration of PCT in the DCQT group was obviously lower than it in the control group(P<0.05), at day 15, the concentrations of PCT in the combined group and the probiotic group were significantly lower in comparision with it in the control group(P<0.05), meanwhile, the concentration of PCT in the combined group was dramatically lower than those in the DCQT group(P<0.05).2.3 Effects on APACHEⅡand SIRS scoresThe scores of APACHEⅡand SIRS showed no differences in the 4 groups(P>0.05).2.4 Effects on the rates of infection, duration of mechanical ventilation and length of ICU stayThere were less patients in the combined group got wound infection than that in the control group(P<0.05); In the comparison of the rates of duration of mechanical ventilation,the 4 groups showed no statistically dramatic differences(P>0.05); the combined group showed a shorter length of ICU stay than the control group(P<0.05).Conclusions:1. The levels of MTL and VIP can be in disorder in patients with severe trauma. Dachengqi Decoction combined with probiotics can improve the level of serum MTL and VIP, improve the intestinal motility disorders in patients post-traumatic and have better effects than the two drugs used respectively.2. The intestinal barrier can be impaired in patients with severe trauma with the serum D-Lac and DAO increasing. Dachengqi Decoction combined with probiotics can lower the concentrations of serum DAO and D-Lac, protect intestinal mucosa barrier in patients post-traumatic.3.Dachengqi Decoction combined with probiotics have much better effect in reducing the rates of constipation, the incidence of gastrointestinal bleeding, and shorten the the first defecation time than the two drugs used respectively.4. Dachengqi Decoction combined with probiotics have much better effect in improving the nutritional status, reducing inflammation and the rate of wound infection, shortening the length of ICU stay in patients with severe trauma in patients than the drugs used respectively. |
