Effect Of Improved Management Of Acute Gastrointestinal Injury On Prognosis In Critical Ill Patients

Object:Based on the optimized prevention and management integrated traditional Chinese and western medicine of severe acute gastrointestinal injury that has been screened out in clinical studies,the paper explored the influence of three different preventing management plans of acute gastrointestinal injury in critically ill patients on prognosis of critically ill patients,to select a beneficial optimizing management plan which can have a good intervention for the prognosis.Method:In this prospestive,randomized,controlled and single blind trial,120 Patients who met the AGI diagnostic criteria,inclusion criteria and exclusion criteria were admitted to department of Intensive Care Unit(ICU),Guangzhou hospital of Traditional Chinese Medicine(TCM),the second hospital of Guangdong province of TCM and Liwan People's hospital from September 2017 to March 2019.Firstly use NUTRIC score to divide 120 trial patients into two group,the NUTRIC<5 patients into low risk group,the NUTRIC?5 patients into high nutritional risk groups,each group was 60 cases.Acording to the random numbers in computer,all patients were divided into group 1,group 2,group 3,group 1 have 33 cases,group 2 have 39 cases,group 3 have 31 cases,which 17 patients were shedding cases.When haemodynamics were relatively stable,no sevre acid-base and electrolyte' s turbulences after moved into ICU,prepared formulated plan was strictly conducted,group 1 was early enteral nutrition and delayed parenteral nutrition(target calories by 60%can' t be reached after 3-days EN,add PN)and Chinese herbal medicine,group 2 was early enteral nutrition and delayed parenteral nutrition(For patients with low malnutrition risk whose NUTRIC<5,target calories by 60%can' t be reached after 7-days EN,add PN;For patients with high malnutrition risk whose NUTRIC?5,parenteral nutrition should be added as soon as possible after admission to ICU)and Chinese herbal medicine,group 3 was as the same as group 2 without Chinese herbal medicine,course of treatment was 10 days.At the same time,we recorded Acute Physiology and Chronic Health Evalution(APACHE)? score,Sepsis Related Organ Failure Assessment(SOFA)score,Glasgow coma scale(GCS)score,NUTRIC score,Intra-abdominal Pressure(IAP),Abdominal Perfusion Pressure(APP),ICU stay and monitored alanine aminotransferase(ALT),aspartate aminotransferase(AST),tatol bilirubin(TBIL),direct bilirubin(DBIL),indirect bilirubin(IBIL),total protein(TP),albumin(ALB),blood urea nitrogen(BUN),creatinine(CR),lactic acid(LAC)and other data in first day and last day.Comparing the effect of three schemes on obove index,to investigate the protect function of three different schemes on prognosis.ResuIt:There was no significant difference in age and gender among the three groups(P>0.05).There was no significant difference in ALT,AST,TBIL,DBIL,IBIL,TP,ALB,CR,BUN level between the three groups after treatment(P>0.05).ALT,AST,TBIL,DBIL,IBIL,CR,BUN level after treatment in the group 1 was significantly lower than before treatment(P<0.05).The levels of TP and ALB in the group 2 were significantly higher after treatment than before treatment(P<0.05).There was no significant difference in Lac level between the three groups after treatment(P>0.05),Lac level was significantly lower in the group 2 after treatment than before treatment(P<0.05),and there was no significant difference in Lac level in the group 1 and group 3 before and after treatment(P>0.05).There was no significant difference in IAP level between the three groups before treatment,after treatment and before and after treatment(P>0.05),and IAP level after treatment in the group 1 was significantly lower than before treatment(P<0.05).There was no significant difference in the difference between the three groups in APP level before,after and before and after treatment(P>0.05),and there was a significant difference in APP level after treatment compared with before treatment in the group 1(P<0.05).There was no significant difference between the three groups in NUTRIC,APACHEII,SOFA and GCS scores before,after and after treatment(P>0.05).In group 1,there were significant differences in NUTRIC,APACHEII and SOFA scores after treatment(P<0.05),and significant differences in GCS scores after treatment(P<0.05).There was no signifiCant difference in NUTRIC,APACHEII,SOFA and GCS scores in the group 2 and group 3 before and after treatment(P>0.05).There were significant differences of the number of patients who have over 80 years old among the three groups(P<0.05).The number of patients who have over 80 years old in the first group was significantly higher than that in the second and third groups.There were no significant differences in the target calories compliance rate,target calories compliance time,ICU hospitalization time,ICU fatality rate and 28-day survival rate among the three treatment groups(P>0.05).But the percentage of ICU case fatality is group 2<group 1<group 3;Percentage of 28-day survival group 3>group P>group 2.Conclusion:The ICU fatality rate and 28-day survival rate of group 1 were in the middle among the three plans,with the best consistency.The comprehensive evaluation of group 1 is superior to group 2 and 3.This study suggested that the 2016 SCCM/ASPEN guidelines recommended the timing of adding intravenous nutrition under NUTRIC score(For patients with low malnutrition risk whose NUTRIC<5,target calories by 60%can't be reached after 7-days EN,add PN;For patients with high malnutrition risk whose NUTRIC?5,parenteral nutrition should be added as soon as possible after admission to ICU),which is not better than the recommendation of enteral nutrition for critical patients as early as possible(24-48 hours after admission to ICU)proposed by SCCM/ASPEN in 2009 and China nutrition guidelines in 2006,and intravenous nutrition should be added if enteral nutrition fails to reach 60%of the target calories within 3 days.