| Object:To explore the influence of three different critically ill patients with gastrointestinal dysfunction prevention, treatment and management bundles on liver and kidney function indices, to screening out a beneficial optimizing scheme which can improve liver and kidney function.Method:In this prospective, randomized, single blind and controlled trial,120 patients who met the AGI diagnostic criteria, inclusion criteria and exclusion criteria were admitted to department of Critical Care Medicine, Guangzhou Hospital of Traditional Chinese Medicine (TCM) and Guangdong General Hospital from 2014 Jule to 2016 February. All patients were randomly divided into three groups, each group have 40 cases.37 patients were shedding cases, who were unfull treatment patients with giving up, lack of obersvation indices at the end of therapy and had side effects. Finally, group 1 had 28 cases, group 2 had 25 cases, group3 had 30 cases. When haemodynamics were relatively stable, no severe acid-base and electrolyte’s turbulences after moved into ICU, formulated scheme was strictly conducted. Group 1 was early restrictive enteral nutrition and parenteral nutrition and Chinese herbal medicine, group 2 was early reasonable enteral nutrition and delayed parenteral nutrition and Chinese herbal medicine, group 3 was early reasonable enteral nutrition and delayed parenteral nutrition, course of treatment was 7 days. At the same time, we recorded Acute Physiology and Chronic Health Evalution (APACHE) II score, Sepsis Related Organ Failure Assessment (SOFA) score.mechanical ventilation, continuous renal replacement therapy (CRRT), supplemented K+,Na+, Ca++,Mg+,P+, albumin and insulin before finishing treatment and other data in the process of treatment, and monitored alanine aminotransferase (ALT), aspartate aminotransferase (AST),tatol bilirubin (TBIL),direct bilirubin (DBIL), indirect bilirubin (IBIL), total protein (TP), albumin(ALB), prealumin (PA), lactic acid (Lac), blood urea nitrogen (BUN), creatinine (Cr), HC03" and other data before and after treatment. Comparing the effect of three schemes on obove index, to investigate the protective function of three different schemes on liver and kidney function.Result:There were no statistical significance of age, gender, APACHEII score, SOFA score, mutiple organ dysfunction syndrome (MODS) rate, sepsis shock, liver and kidney function before into group and K+, Na+, Ca++, Mg+,P+,albumin, insulin amount and mechanical ventilation rate and CRRT rate in the process of treatment, serum AST, TBIL, DBIL, IBIL, Cr in posttreatment were significantly lower than pretherapy in group 2, and HC03-was higher [(21.5,42.0,121.0)VS (18.0,25.0, 38.5),(9.3,19.2,27.4)VS(7.8,13.6,19.9), (5.3,7.3,17.0)VS(4.6,6.5, 11.3), (3.4,5.9,15.1)VS(2.2,15.3,9.9), (54.5,135.0,255.5) VS (41.5,81.0, 174.5), (23.40+7.11) VS (26.40+6.71), all P<0.05]; ALB in group 1 and 3 were prominent descend after cured [(33.18+5.67)VS(31.32+5.28), (30.93 +4.52) VS(29.20+5.65), all P<0.05]. Serum Cr was dramatically descend in group 3 after treatment [(63.8,121.5,271.8) It (59.0,100.0,214.0), K0.05]. In the stratified comparison(abnormal liver and kidney function), abnormal AST and TBIL cases in group 2 were obviously descend [13(52)VS5(20),13(52) VS6(24), all P<0.05]. TBIL before treating was higher than post treatment in group 1 [(21.4,24.3,31.9)VS(27.2,41.8,77.0),P<0.05];There were statistical significance of abnormal AST, TBIL, DBIL, IBIL, BUN, Cr in group 2[(50.5,74.0, 227.5)VS(24.0,34.0,68.0), (21.7,27.3,41.6)VS(15.7,18.6,27.7), (8.7,15.3,33. 6)VS(6.8,10.6,21.), (14.8,16.8,21.5) VS(7.3,12.0,13.6), (9.9,15.0,29.5)VS(7. 8,14.6,25.1), (138.0,202.0,268.5)VS(78.0,107.0,209.0),all P<0.05].ALT, AST and TBIL in group 3 were significantly descend after treatment.Conclusion:Serum AST, TBIL, DBIL, IBIL, BUN, Cr in group 2 after treatment were obviously descend. Group 2(early reasonable enteral nutrition and delayed parenteral nutrition and Chinese herbal medicine) can significantly improve liver and kidney function indices, and have protective function of liver and kidney function. |
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