Miao Zhang,Jun-Chen Fan,Hui-Min Zhang,Qian-Qian Guo,Peng-Yang Li,Hua-Lin Men,Yu-Ling Wang

1Huzhou Center Hospital,Huzhou,Zhejiang,China; 2Tianjin University of Traditional Chinese Medicine,Tianjin,China; 3Tianjin Hospital of ITCWM Nankai Hospital,Tianjin,China.

ABSTRACT

Key words:Acupoint application,Microwave treatment,Moderately severe acute pancreatitis,Intestinal barrier dysfunction

1.INTRODUCTION

Acute pancreatitis (AP) refers to the abnormal activation of pancreatic enzymes due to various reasons,resulting in inflammation of the local or peripheral organs of the pancreas,severe patients with systemic inflammatory response syndrome and accompanied with organ dysfunction [1].AP is divided into mild acute pancreatitis (MAP),moderately severe acute pancreatitis(MSAP),severe acute pancreatitis (SAP) [1 - 2].MSAP,between MAP and SAP,manifests as organ failure time ≤ 48 hours,or no organ failure with local or systemic complications[3].MSAP is prone to paralytic ileus,that is because intestinal dysmotility leads to intestinal dilatation and flatulence,aggravation of gastrointestinal microcirculatory disorders,resulting in damage to the intestinal mucosal barrier,which in turn causes the spread and migration of intestinal bacteria,and the bacteria will directly participate in the inflammatory reaction of pancreatitis,ultimately causing secondary infection of pancreatic necrotic tissue,this is the cause of 80% patients death with pancreatitis [4 - 5].Therefore,early recovery of intestinal barrier function in MSAP is the key link of treatment [6 - 7].In this study,acupoint application combined with microwave treatment was applied to restore the recovery of intestinal barrier dysfunction in MSAP,and achieved certain results.

2.OBJECTS AND METHODS

2.1 Objects

By means of convenience sampling,90 patients who were diagnosed as MSAP in a third-grade class-A general hospital in Tianjin from March to December 2017 were selected as objects.Inclusion criteria:Patients diagnosed with intestinal barrier dysfunction in MSAP after admission; 18 ≤ age ≤ 65 with severe organ dysfunction or shock; mental illness or cognitive impairment; patients in need of surgery,pregnancy,rice wine allergy,patients implanted with a pacemaker,stent,or cardiac electrode in the body.

In this study,the objects were divided into 3 groups with 30 cases in each group.Two patients in the acupoint application group were removed from the ICU due to the aggravation of their condition,one patient in the control group fell off due to reluctance to continue nursing intervention,87 cases of final valid sample data were obtained.A group (acupoint application combined with microwave treatment) 30 cases,age (43.37 ±11.70); B group (acupoint application) 28 cases,age (45.96 ±11.25); C group (usual care) 29 cases,age (42.55 ± 13.77).There was no significant difference in age,sex,disease nature,inducement and other general data among the three groups (P＞0.05).

2.2 Methods

2.2.1 Intervention plan (Table1).

Table1.Details of intervention regime

2.2.2 Research tools.(1) Intestinal function score:The intestinal function score was proposed by the Beijing Municipal Science and Technology Commission's “MODS Diagnosis and Treatment Research” group in 2004 [9].Evaluate the patient's bowel function based on the bowel sounds,defecation,etc.The bowel sounds did not decrease and the bowel movements were normally rated as 0 point; could not hear the bowel sounds or attenuation and does not perform spontaneous defecation rated as 1 point; could not hear the bowel sounds or attenuation and no spontaneous defecation after oral medication rated as 2 points;cannot hear the bowel sounds or attenuation and no spontaneous defecation after enema rated as 3 points; the bowel sounds completely disappeared and without defecation by use a variety of ways rated as 4 points.(2) Record changes in C-reactive protein.(3) Overall treatment effect monitoring:The recovery of intestinal barrier dysfunction in patients with pancreatitis will have an important impact on the overall treatment of patients,monitoring the overall treatment effect of the patients after 10 days of intervention,evaluation of the overall efficacy of treatment with the effective rate of the total treatment.The treatment effect criteria include 3 aspects:1) Excellence:At least one of the two laboratory indicators blood amylase and C-reactive protein returned to normal within 5 days,meanwhile,major clinical symptoms and signs (pain,fever,nausea and vomiting,upper abdominal tenderness,rebound pain) disappeared.2) Better:Within 6 - 10 days,the above laboratory indicators and major clinical symptoms and signs appear to be relieved.3) Invalid:After 10 days of treatment,one or both of the above laboratory indicators have not returned to normal or major clinical symptoms and signs have not been significantly improved or aggravated [10].Excellence+ better = effective.

2.2.3 Evaluation method.Questionnaire survey of patients or their families on the admission day by researcher,and baseline measure the patients’ observation indicators,intestinal function scores and serum C-reactive protein were monitored at 3,7 and 10 days after intervention,respectively,monitoring of overall treatment after 10 days of intervention.

2.2.4 Statistical analysis.The original data was entered into the statistical software SPSS 20.0 for data processing,and the two persons were checked.The count data was expressed by frequency and composition ratio,and analyzed by R × C table chi -square test or rank sum test; the measuring data is expressed as x± s or M (Q),and the normality test is first performed.For example,theF-test which uses multiple sample means to compare the normal distribution is used,and the non-normal distribution data uses the rank of multiple independent samples in the non-parametric test.And testing for analysis,P＜0.05 means statistically significant.

3.RESULTS

3.1 Changes in intestinal function scores of three groups before and after intervention (Table2 and Table3)

Table2.Changes in intestinal function scores of the three groups at different time points

Table3.Pairwise comparison of intestinal function scores of the three groups in different time period

3.2 Comparison of serum C-reactive protein levels among three groups before and after intervention (Table4 and Table5)

Table4.Changes of C-reactive protein in three groups at different time points ( x ± s,mg / L)

Table5.Pairwise comparison of C-reactive protein in three groups in different time period

3.3 Comparison of the overall treatment among the three groups after intervention (Table6 and Table7)

Table6.Comparison of overall treatment efficacy among three groups (n,%)

Table7.Pairwise comparison of the overall efficacy of three groups(n,%)

4.DISCUSSION

4.1 Acupoint application combined with microwave treatment can improve intestinal barrier dysfunction in patients with MSAP

Comparison of intestinal function scores and serum C-reactive protein in three groups after intervention,according to Table2 and Table4,the difference between the three groups of patients is obvious (P= 0.000 ＜ 0.05),explain that different interventions(acupoint application combined with microwave treatment,acupoint application,usual care) have different effects on the recovery of intestinal barrier function in three groups of patients.The internal effect and interaction effect of the three groups of patients were obvious (P= 0.000 ＜ 0.05),it is indicated that the intestinal function scores and C-reactive protein levels of the three groups decreased after the intervention.The results of the study in Table3 and Table5 showed that there is statistical difference (P= 0.028,0.001,0.000,0.001,0.007,0.003 ＜ 0.05)between group A (acupoint application combined with microwave treatment) and group B (acupoint application),the intestinal function score and C-reactive protein level in group A were significantly lower than those in group B,it is showed that acupoint application combined with microwave treatment can promote the recovery of intestinal function in a relatively faster way compared with acupoint application; the results of the study showed that there is statistical difference (P= 0.022,0.013,0.000,0.028,0.000,0.001,0.000 ＜ 0.05) between group B (acupoint application) and group C (usual care),it showed that the effect of acupoint application is more obvious than usual care;there was a significantly statistical difference in the treatment effect between group A and group C,It is indicated that acupoint application combined with microwave treatment is more obvious for patients with intestinal recovery than usual care,further indicating that the joint advantages of the two nursing techniques are more obvious.This is consistent with previous research results.Lin applied Chinese medicine pills to the umbilicus while using microwave to irradiate the patient's umbilicus,which promoted the recovery of intestinal motility in postoperative patients [11].

Acupoint application is mainly used to directly absorb the drug through specific acupuncture point and to stimulate the meridians and collaterals to regulate the function of the organs to achieve the purpose of treating diseases [12].According to the recent research on acupoint application in the treatment of intestinal function and the function of each acupuncture point [13 -15].The study selected Shenque (CV8),Zhongwan (CV12) as the main point,bilateral Tianshu (ST25),Liangmen (ST21) as auxiliary points,traditional Chinese medicine believes that the umbilical is the place where is the Shenque (CV8),Conception Channel,Governor Channel,Chong Channel convergence at Shenque (CV8),and it is closely linked the whole zang-organs and fu-organs and their respective meridians and collaterals,can pass through all vessels,cure all diseases,such as borborygmus,constipation,etc [16].Tianshu (ST25),Liangmen (ST21) belong to Yangming Stomach Channel of Foot,play an important role in regulating the gastrointestinal tract.In this study,the acupoint application drug ingredients were mainly based on the addition and subtraction of Qingyitang decoction,including golden thread (Rhizoma Coptidis) rhubarb root and rhizome (Radix et Rhizoma Rhei),crystallized sodium sulfate (Natrii Sulfas),officinal magnolia bark (Cortex Magnoliae Officinalis),immature orange fruit (Fructus Aurantii Immaturus).Rhubarb root and rhizome (Radix et Rhizoma Rhei) is bitter in flavor and cold in propert,acting on the spleen,stomach,liver and gall,large intestine channels,can remove accumulation with purgation,cleaning up gastrointestinal stagnation.crystallized sodium sulfate (Natrii Sulfas) is bitter in flavor and cold in propert,acting on the spleen,stomach large intestine channels,can eliminate stasis and improve circulation [18].Golden thread (Rhizoma Coptidis) can lower fire and dry dampness,dispersing stagnated liver qi and regulating qi-flowing.Officinal magnolia bark (Cortex Magnoliae Officinalis) and immature orange fruit (Fructus Aurantii Immaturus) can dispers abdominal mass and eliminate stasis,acupoint application of drug ingredients can effectively promote the recovery of intestinal function in patients.In this study,the microwave irradiation of specific acupoints was added on the basis of acupoint application,microwave belongs to a kind of high frequency electric wave with strong penetrating effect.Microwave treatment can cause human tissue,especially the inflammation site,to increase the stimulation of acupoints by internal heat production,at the same time,relevant research indicates that after microwave treatment of specific acupoints,it can play a role of "acupuncture" and improve the effect of acupoint application [19].Studies have further pointed out that microwave treatment can also exert biological effects,improve the body's immunity,accelerate the regression of inflammation,and promote the recovery of intestinal barrier function [20].The study combines microwave treatment with acupoint application,fully use their respective advantages and achieve good results,in some extent,the advantages of acupoint application combined with microwave treatment compared with acupoint application for restoring intestinal barrier function with MSAP were confirmed.

4.2 Acupoint application combined with microwave treatment can improve the overall treatment of patients with MSAP

Comparison of the overall treatment efficient of three groups of patients after 10 days of intervention,Table6 showed the difference in overall treatment efficient between the three groups (P= 0.001 ＜ 0.05),explain that three different interventions have different effects on the overall treatment efficient of the three groups (acupoint application combined with microwave treatment,acupoint application,usual care); the overall treatment efficient of three groups was compared in two pairs,Table7 showed that there was no significant difference (P= 0.191 ＞0.05) in the overall treatment efficient between group A (acupoint application combined with microwave treatment) and group B (acupoint application).Firstly,it may be related to the small sample size included in this study,the overall treatment efficient of the three groups was relatively poorly representative.It is suggested to expand the sample size in future research and demonstrate the effect of acupoint application combined with microwave treatment and acupoint application on the overall treatment effect of patients with pancreatitis.Second,reflect the relative safety of microwave treatment based on acupoint application,there was no significant difference in the overall treatment between group A (acupoint application combined with microwave treatment) and group B (acupoint application),to a certain extent,it was relatively safe to add microwave treatment on the basis of acupoint application,compared with acupoint application,it did not adversely affect the overall treatment of patients.Third,under the premise of small sample research,there was no statistical difference in the overall treatment efficient between group A (acupoint application combined with microwave treatment) and group B (acupoint application),but Table6 showed that there was a difference in the overall treatment efficient between the two groups,group A was 93.33%,group B was 82.14%,group A was higher than group B,it indicated that there was no statistical difference in the overall treatment efficient between the two groups of A B patients,but it has certain reference value in practical clinical significance; there was a statistical significantly difference in the overall treatment efficient between group B (acupoint application) and group C(usual care) (P= 0.015 ＜ 0.05),it can be seen from Table7 that the overall treatment efficient of group B was higher than group C,it showed that acupoint application can improve the overall treatment effect more effectively than usual care.There was a statistical significantly difference in the overall treatment efficient between group A and group C (P= 0.000 ＜ 0.05),it showed that acupoint application combined with microwave treatment can improve the overall treatment effect than usual care.In the summary,acupoint application combined with microwave treatment or acupoint application can improve the overall treatment effect compared with usual care in some extent.

5.SUMMARY

In this study,90 patients were treated with different interventions to evaluate the effect of acupoint application combined with microwave treatment on intestinal barrier dysfunction in patients with MSAP.However,there are still some shortcomings,such as fewer biochemical indicators,which need to be improved in later research.

Authors’ contributions

ZM wrote the manuscript.ZM,WYL and FJC designed the research and edited the manuscript.ZHM and GQQ collected and processed the data.LYP organized the literatures.MHL proofread the article

Acknowledgments

The authors gratefully acknowledge the authors who list in those literatures which were cited in the present review.

Financial support and sponsorship

None.

Patient consent

Not applicable.

Ethics approval

Not applicable.