| ObjectivesBy comparing D- lactic acid, diamine oxidase level, gastrointestinal dysfunction score, APACHE II score, ICU length of stay, MODS incidence and mortality, the research try to explore the effect of different administrations of rhubarb on gastrointestinal function of critically ill patients and determine the best administration way,so as to seek a safe, effective, economic and feasible gastrointestinal tract protective measure for improving gastrointestinal function and prognosis of the disease and alleviating the suffering of patients.MethodsThis study was a clinical quasi-experimental trial. The randomized block experimental design were chosen 80 patients(APACHE II 20-30) who were hospitalized in ICU of the Seventh people’s hospital of Shenzhen were selected during from October,2013 to March, 2015.Then the samples were assorted into four Groups according to the operative turn by A,B,C,D cycle, 20 cases of each group.Four groups were treated with routine therapy and care positively. Group A :nasal feeding+ enema, Group B: nasal feeding, Group C: enema, rhubarb was uesd one time a day after hospitalized within 6h; Group D(control Group) was given gastrointestinal routine care.The intervention was as long as 7 days.Information of all patients was recorded.The level of D-lactic acid and DAO, APACHE II scores,gastrointestinal dysfunction score, the length of stay in ICU, the incidence of MODS and mortality were recorded and analyzed. The Information were collected and statistical analyzed.Results1.The study included 80 cases, 77 effective cases, one patient in Group B switched departments, two patients gave up treatment and left in Group C. Pairwise comparisons of demographic, disease-related information of four Groups showed no significant difference(P> 0.05).2.Laboratory index2.1Repeated measures analysis of variance showed that D-lactate level of four groups in using different interventions and time were statistically significant difference((F=4.224,27.082,P < 0.05),there were significant interactions between intervention and time on D-lactate level(F=4.135,P<0.05); D-lactate levels of four groups decreased as time went by gradually and Group A showed the largest decline The comparison between groups at different time showed that:. Before intervention,1thday and 4thday the D-lactic level of four groups showed no significant difference(F=1.300,2.347,1.815,P>0.05), 7th day showed significant difference(F=2.935,P<0.05).Pairwise comparison among the four groups Group A with Group B,C,D and Group B with Group C,D were statistically significant P < 0.05; there was no significant differences between Group C and Group D(P>0.05).2.2Repeated measures analysis of variance showed that DAO level of four groups in using different interventions and time were statistically significant difference((F=1146.003,5.526,P < 0.05),there were significant interactions between intervention and time on D-lactate level(F=3.142,P<0.05); DAO levels of A,B,C groups decreased as time went by gradually and Group D declined first then increased.The comparison between groups at different time showed that:. Before intervention,1thday and 4th day the D-lactic level of four groups showed no significant difference(F= 0.710,0.189,0.780,P>0.05), 7thday showed significant differences(F= 2.805,P<0.05).Pairwise comparison among the four groups Group A with Group B,C,D and Group B with Group C,D were statistically significant P < 0.05; there was no significant differences between Group C and Group D(P>0.05).3.The gastrointestinal dysfunction score of four groups before intervention showed no statistically significant(F=1.329,P>0.05), but had statistically significant after intervention(F=73.844,P<0.05). Pairwise comparison of four groups: Group A with Group B,C,D and Group B with Group C,D were statistically significant P<0.05; there was no significant differences between Group C and Group D(P>0.05).4.The abdominal pressure of the four groups before intervention showed no statistically significant(F=0.595,P > 0.05); but had statistically significant after intervention(F =34.944,P<0.05).Pairwise comparison of four groups: Group A,B,C with Group D were statistically significant difference(P < 0.05);There were nosignificant statistical difference in Group A with Group B,C, Group B with Group C(P>0.05).5.The APACHE II score of the four groups before intervention showed no statistically significant(F=2.619,P > 0.05); but had statistically significant after intervention(F =9.494,P<0.001). Pairwise comparison of four groups: Group A with Group B,C,D and Group B,C with Group D were statistically significant(P<0.05);there was no significant differences between Group B and Group C(P>0.05).6.The incidence of MODS and the length of stay in ICU of the four groups showed statistically significant(χ2=12.785, F =3.207,P<0.05),Pairwise comparison among the four Groups : the differences of Group D with Group A,B,C was statistically significant( P<0.05);the differences of Group A with Group B,C and Group B with Group C showed no statistically significant( P>0.05). The mortality difference was not statistically significant(χ2=4.252, P>0.05)Conclusions1.Rhubarb had a good protective effect on gastrointestinal function of critically ill patients.Compared with single nasal feeding, enema and conventional nursing method,the effect of rhubarb nasal feeding combined enema was better, which could obviously reduce the lactic acid and DAO D-level, improve the gastrointestinal mucous membrane permeability and gastrointestinal dysfunction, and reduce the incidence of MODS, shorten ICU length of hospital stay, and improve the prognosis of patients.2.Rhubarb nasal feeding combined enema was safe and economic and easy to operate. It had good clinical value and application prospects, it could also offer a new theory for gastrointestinal protection of critically ill patients. |
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