Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis

Summary

An enema is a type of traditional Chinese medicine (TCM) therapy used to treat severe acute pancreatitis (SAP). The therapy involves instilling a TCM liquid into the rectum and colon through the anus to keep the liquid in the intestine, absorbing through the intestinal mucosa. This study aims to standardize the enema procedure for SAP patients.

Abstract

Severe acute pancreatitis (SAP) is characterized by high mortality rates, numerous complications, and extreme difficulties in treatment. A traditional Chinese medicine (TCM) enema has been widely utilized in clinical and experimental studies of SAP. It has been demonstrated to have beneficial effects in protecting pancreatic function and delaying disease progression. The procedure of TCM enema is to perfuse the Chinese medicinal liquid of raw rhubarb (Rheum officinale Baill. DaHuang) from the anus into the rectum and colon. Basic steps of the procedure include boiling the herbal solution in advance, using a disposable enema kit to assist patients in taking a left lying position, raising the patient's hip 10 cm, and carefully inserting the enema 30-35 cm into the anus, with a drip speed of 60-80 drops/min. The medicine liquid temperature should be equivalent to the patient's body temperature, typically between 37-39 °C. The end of the enema operation should be slow, and Tui na (massage therapy) should be administered before extubation. The medication liquid should be kept in the rectum for more than 1 h. After issuing an enema, it is essential to observe the patient's feces and abdomen, and to evaluate the remission of abdominal signs and symptoms.

Introduction

Acute pancreatitis (AP) is an acute abdominal disease, characterized by a local pancreatic inflammatory response from an abnormal activation of pancreatic enzymes that have a digestive effect on the pancreas and surrounding organs¹. As one of the most prevalent gastrointestinal reasons for hospitalization in the United States, acute pancreatitis requires increasing attention as it continues to increase worldwide^2,3. In the past decade, the understanding of the pathophysiological mechanisms of acute pancreatitis has made significant strides^4,

Protocol

The clinical protocol has been approved by the Administrative Committee of Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine (Record number: KY20221005). Experimental procedures were carried out in accordance with the guidelines of Hospital of Chengdu University of Traditional Chinese Medicine. The consent of the patients, who have signed an informed consent form, is required for the operation. The operator should understand the anatomy of the rectum before administering the enema and look at the anatomical annotations (see Figure 3).

1. Pre-therapy prepa....

Results

In this study, the patient was admitted because of repeated epigastric pain. According to the diagnostic criteria³⁰, the patient was diagnosed with SAP. After the patient was treated with this protocol, there was a noted therapeutic effect³¹.

Patient A, a female, 84 years old, was diagnosed for the first time on May 2, 2019. The patient complained of repeated epigastric distension and pain. The clinical tests showed that the serum amylase was 509.......

Discussion

AP is an inflammatory disease that can progress to SAP. According to numerous studies, SAP is a devastating disease linked with mortality ranging from less than 10% to as high as 85%, albeit with decreasing mortality in the recent decade³³. SAP seriously impacts patients' quality of life, and can even lead to death if not treated promptly and effectively. Aggressive and effective early treatment is of clinical importance³⁴.

Chinese herbal ene.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Automatic decoction machine packaging machine	Taizhou Guo pin Le Ji Machinery Co., Ltd	GPJ13(1+1)
Care turning pillows	Hengshui Binhu New Area Fubon Medical Equipment Factory	20220902R
Disposable enema device	Yangzhou Yuankang Medical Equipment Co., Ltd.	20220502B
Disposable gloves	Jiangxi Almei Medical Equipment Co., Ltd.	AEM/ST-AZ
Disposable medical kit	Zhende Medical Supplies Co., Ltd.	20211220
Disposable treatment sheet	Xinxiang Huakang Eisai Co., Ltd	HK-38
Medical gauzepad	Xinxiang Huakang Eisai Co., Ltd	HK-02B
Medical nursing pad	Hefei Mattel Care Products Co., Ltd	CND502
Non-woven Filter Package	Chengdu New Medical and Health Products Factory	20192183#(C)
Paraffin oil	Shandong Lierkang Medical Technology Co., Ltd.	180801
Raw rhubarb	Sichuan Guoqiang traditional Chinese Medicine  Co., Ltd	21120104
Thermometer	Shenzhen Chenzhou Technology Co., Ltd.	TP300