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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 10  |  Page : 1142-1150

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically Ill Patients: A Retrospective Study Based on Propensity Score Matching


Department of Emergency Medicine, Changzheng Hospital, The Second Military Medical University, Shanghai 200003, China

Correspondence Address:
Prof. De-Chang Chen
Department of Emergency Medicine, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Shanghai 200003
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.231523

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Background: Gastrointestinal dysfunction plays a critical role in the prognosis of critically ill patients. Previous studies showed rhubarb, a traditional Chinese herb, can protect the intestinal barrier function, prevent intestinal bacterial translocation, and promote gastrointestinal peristalsis, but the clinical studies are less. The aim of this study was to evaluate the effects of rhubarb on gastrointestinal dysfunction in critically ill patients. Methods: From June 2015 to May 2017, a total of 368 critically ill patients with Grade I–III acute gastrointestinal injury (AGI) were enrolled in this study. Patients were divided into two groups according to the exposure factors (whether the patients received rhubarb treatment): the rhubarb group and the usual treatment group. Clinical data were collected within the first 24 h of the Intensive Care Unit (ICU) admission and 7 days after treatment. Survival data on day 28 after ICU admission and the durations of ICU and total hospitalization were also collected. Propensity score matching (PSM) was conducted to reduce confounding bias between the groups. The logistic regression was conducted to screen the influence factors. Results: The eligible patients were divided into rhubarb group (n = 219, 59.5%) and usual treatment group (n = 149, 40.5%). Before PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group were 59.8% and 39.6%, respectively. After PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group was 77.9% and 30.9%, respectively. The remission rates of feeding intolerance in rhubarb group were significantly higher than those in the usual treatment group (all P < 0.05). Compared with the usual treatment group, the rhubarb group had a higher rate of AGI improvement, lower level of C-reactive protein, shorter stay in ICU before and after PSM (P < 0.05). There was no significant difference in 28-day mortality between rhubarb and usual treatment groups before and after PSM (48 vs. 33, P = 0.959; and 16 vs. 21, P = 0.335). The logistic regression analysis showed that the single factor, whether receiving rhubarb therapy, affected the proportion of patients whose enteral nutrition needs ≥83.7 kJ·kg−1·d−1 after 7 days of treatment (odds ratio: 7.908, 95% confidence interval: 3.661–17.083, P < 0.001). No serious adverse effects were found in two groups. Conclusions: The rhubarb might significantly improve feeding tolerance and relieve gastrointestinal dysfunction in critically ill patients, without serious adverse reactions. It provided proof for the treatment of gastrointestinal dysfunction with rhubarb during clinical practice.

 

 Abstract in Chinese

大黄对危重症患者胃肠功能障碍的治疗作用:一项基于倾向性评分匹配法的回顾性研究

摘要

背景:胃肠功能障碍对危重症患者的预后起着至关重要的作用。前期研究表明大黄,作为一种传统中药,能够有效保护胃肠道屏障功能,阻止肠道细菌移位,促进胃肠道蠕动,但至今临床研究较少。本研究的目的在于探讨中药大黄对危重症患者胃肠功能障碍的治疗作用。

方法:2015年6月至2017年5月期间共有368位患有I–III级急性胃肠道损伤(AGI)危重症患者纳入本次回顾性研究。根据暴露因素(即胃肠功能障碍患者是否接受大黄治疗)将患者分为大黄组和常规治疗组。收集患者进入重症监护室(ICU)24小时内及治疗7天后的临床资料,及患者28天死亡率、ICU入住时间和总住院时间。采用倾向性评分匹配法(PSM)控制两组间的混杂偏倚,用Logistic回归分析模型筛选影响因素。

结果:根据是否使用大黄治疗,入选患者被分为大黄组(219例,59.5%)和常规治疗组(149例,40.5%)。PSM匹配前大黄组和常规治疗组喂养耐受率分别为59.8%、39.6%,PSM匹配后大黄组和常规治疗组喂养耐受率分别为77.9%、30.9%,大黄组喂养耐受率均较常规治疗组高,差异有统计学意义(P<0.05)。PSM匹配前后大黄组患者AGI分级改善率均较常规治疗组高, ICU入住天数、CRP水平均较常规治疗组低,差异有统计学意义(P<0.05)。两组患者在PSM匹配前后28天死亡率均无统计学差异(48 vs. 33, P=0.959; and 16 vs. 21, P=0.335)。Logistic回归分析显示,仅是否接受大黄治疗这一因素影响治疗7天后肠内营养需求≥ 83.7 kJ·kg-1·d-1的患者的比例。两组患者均未发现严重不良反应。

结论:中药大黄能够有效提高危重症患者肠内营养耐受性,缓解胃肠功能障碍,且无严重不良反应,为临床实践中应用大黄治疗胃肠功能障碍提供了循证医学证据。



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