目的 观察大黄对严重烧伤患者胃肠动力及肠黏膜屏障的影响.方法 选择太钢总医院2009年12月-2010年12月收治的30例严重烧伤患者,按随机数字表法分为对照组14例、治疗组16例.所有患者均于伤后48 h内入院,入院后6h内留置鼻胃管.治疗组患者入院后6h开始鼻饲大黄10 g,3次/d,并口服L-谷氨酰胺颗粒5 g,3次/d;入院后24 h开始进行肠内营养.对照组患者不使用大黄,其余各项营养支持治疗措施(口服L-谷氨酰胺颗粒、给予肠内营养)均与治疗组相同.观察2组患者用药后腹胀、对肠内营养的耐受、24 h肠鸣音恢复、排便等胃肠功能一般情况.于2组患者伤后3、7、14d清晨取静脉血分离血清,放射免疫法测定胃泌素水平,ELISA法测定胃动素水平,鲎试剂动态浊度法测定内毒素水平,酶学分光光度法测定二胺氧化酶活性.计数资料数据采用x2检验,计量资料数据采用t检验.结果 与对照组比较,治疗组患者的腹胀发生例数较少(x2=4 84,P =0.025),对肠内营养耐受例数及24 h肠鸣音恢复例数较多(x2=5.01,P=0 031;x2=4 84,P =0.028),排便时间明显提前,排便次数增加,大便较软.治疗组患者伤后3、7、14d血清胃泌素水平分别为(92±26)、(95±16)、(98±18) ng/L,均高于对照组[(80±15)、( 75±17)、(79 ±13) ng/L,t值分别为15.352、22.951、19.263,P值均小于0.01].治疗组伤后3、7、14 d血清胃动素水平分别为(246±80)、(299±76)、(300±1 00) ng/L,明显高于对照组[(189±44)、( 203±64)、(200±67) ng/L,t值各为14.173、19.294、26.298,P值均小于0 01].治疗组伤后3、7、14d血清内毒素水平分别为(0.398±0 035)、(0.373±0 005)、(0.238±0 019) EU/mL,均低于对照组[(0.493±0.043)、(0.501±0.045)、(0.423±0.099)EU/mL,t值分别为6 213、9.153、15.134,P＜0.05或P＜0.01].治疗组伤后3、7d血清二胺氧化酶活性分别为(3 0±0 4)、(2 9±0.5)U/mL,均低于对照组[(3 9±0 5)、(3 6±0.6)U/mL,t值分别3 982、4 236,P值均小于0.05]；伤后14d2组水平接近(t =1.762,P＞0 05).结论 大黄能增加烧伤患者胃肠激素水平-促进其胃肠动力恢复,从而保护患者胃肠黏膜屏障功能.
目的 觀察大黃對嚴重燒傷患者胃腸動力及腸黏膜屏障的影響.方法 選擇太鋼總醫院2009年12月-2010年12月收治的30例嚴重燒傷患者,按隨機數字錶法分為對照組14例、治療組16例.所有患者均于傷後48 h內入院,入院後6h內留置鼻胃管.治療組患者入院後6h開始鼻飼大黃10 g,3次/d,併口服L-穀氨酰胺顆粒5 g,3次/d;入院後24 h開始進行腸內營養.對照組患者不使用大黃,其餘各項營養支持治療措施(口服L-穀氨酰胺顆粒、給予腸內營養)均與治療組相同.觀察2組患者用藥後腹脹、對腸內營養的耐受、24 h腸鳴音恢複、排便等胃腸功能一般情況.于2組患者傷後3、7、14d清晨取靜脈血分離血清,放射免疫法測定胃泌素水平,ELISA法測定胃動素水平,鱟試劑動態濁度法測定內毒素水平,酶學分光光度法測定二胺氧化酶活性.計數資料數據採用x2檢驗,計量資料數據採用t檢驗.結果 與對照組比較,治療組患者的腹脹髮生例數較少(x2=4 84,P =0.025),對腸內營養耐受例數及24 h腸鳴音恢複例數較多(x2=5.01,P=0 031;x2=4 84,P =0.028),排便時間明顯提前,排便次數增加,大便較軟.治療組患者傷後3、7、14d血清胃泌素水平分彆為(92±26)、(95±16)、(98±18) ng/L,均高于對照組[(80±15)、( 75±17)、(79 ±13) ng/L,t值分彆為15.352、22.951、19.263,P值均小于0.01].治療組傷後3、7、14 d血清胃動素水平分彆為(246±80)、(299±76)、(300±1 00) ng/L,明顯高于對照組[(189±44)、( 203±64)、(200±67) ng/L,t值各為14.173、19.294、26.298,P值均小于0 01].治療組傷後3、7、14d血清內毒素水平分彆為(0.398±0 035)、(0.373±0 005)、(0.238±0 019) EU/mL,均低于對照組[(0.493±0.043)、(0.501±0.045)、(0.423±0.099)EU/mL,t值分彆為6 213、9.153、15.134,P＜0.05或P＜0.01].治療組傷後3、7d血清二胺氧化酶活性分彆為(3 0±0 4)、(2 9±0.5)U/mL,均低于對照組[(3 9±0 5)、(3 6±0.6)U/mL,t值分彆3 982、4 236,P值均小于0.05]；傷後14d2組水平接近(t =1.762,P＞0 05).結論 大黃能增加燒傷患者胃腸激素水平-促進其胃腸動力恢複,從而保護患者胃腸黏膜屏障功能.
목적 관찰대황대엄중소상환자위장동력급장점막병장적영향.방법 선택태강총의원2009년12월-2010년12월수치적30례엄중소상환자,안수궤수자표법분위대조조14례、치료조16례.소유환자균우상후48 h내입원,입원후6h내류치비위관.치료조환자입원후6h개시비사대황10 g,3차/d,병구복L-곡안선알과립5 g,3차/d;입원후24 h개시진행장내영양.대조조환자불사용대황,기여각항영양지지치료조시(구복L-곡안선알과립、급여장내영양)균여치료조상동.관찰2조환자용약후복창、대장내영양적내수、24 h장명음회복、배편등위장공능일반정황.우2조환자상후3、7、14d청신취정맥혈분리혈청,방사면역법측정위비소수평,ELISA법측정위동소수평,후시제동태탁도법측정내독소수평,매학분광광도법측정이알양화매활성.계수자료수거채용x2검험,계량자료수거채용t검험.결과 여대조조비교,치료조환자적복창발생례수교소(x2=4 84,P =0.025),대장내영양내수례수급24 h장명음회복례수교다(x2=5.01,P=0 031;x2=4 84,P =0.028),배편시간명현제전,배편차수증가,대편교연.치료조환자상후3、7、14d혈청위비소수평분별위(92±26)、(95±16)、(98±18) ng/L,균고우대조조[(80±15)、( 75±17)、(79 ±13) ng/L,t치분별위15.352、22.951、19.263,P치균소우0.01].치료조상후3、7、14 d혈청위동소수평분별위(246±80)、(299±76)、(300±1 00) ng/L,명현고우대조조[(189±44)、( 203±64)、(200±67) ng/L,t치각위14.173、19.294、26.298,P치균소우0 01].치료조상후3、7、14d혈청내독소수평분별위(0.398±0 035)、(0.373±0 005)、(0.238±0 019) EU/mL,균저우대조조[(0.493±0.043)、(0.501±0.045)、(0.423±0.099)EU/mL,t치분별위6 213、9.153、15.134,P＜0.05혹P＜0.01].치료조상후3、7d혈청이알양화매활성분별위(3 0±0 4)、(2 9±0.5)U/mL,균저우대조조[(3 9±0 5)、(3 6±0.6)U/mL,t치분별3 982、4 236,P치균소우0.05]；상후14d2조수평접근(t =1.762,P＞0 05).결론 대황능증가소상환자위장격소수평-촉진기위장동력회복,종이보호환자위장점막병장공능.
Objective To observe the influence of rhubarb on gastrointestinal motility and intestinal mucosal barrier in patients with severe burn.Methods Thirty patients with severe burn admitted to our burn wards within 48 hours after burn injury from December 2009 to December 2010 were divided into therapeutic group (T,treated with 10 g rhubarb by nasal feeding and 5 g L-glutamine by oral administration beginning from 6 hours after admission,three times per day,and also given enteral nutrition beginning from 24 hours after admission,n =16) and control group (C,received the same treatment as used in T group but without rhubarb,n =14) according to the random number table.Gastrointestinal function indexes including restoration of bowel sound within 24 hours,abdominal distension,tolerance to enteral nutrition,and defecation were observed after treatment.The serum samples were harvested on post burn day (PBD) 3,7,14 for determination of the levels of gastrin (GAS) by radioimmunoassay,motilin (MTL) by enzyme-linked immunosorbent assay,diamine oxidase (DAO) by enzyme spectrophotometry,and endotoxin (ET) by kinetic turbidimetric assay with TAL.Data were processed with t test and chi-square test.Results Compared with those in C group,the numbers of patients with restoration of bowel sound within 24 hours and tolerance to enteral nutrition in T group were increased ( withx2 value respectively 5.01,4.84,P values all below 0.05 ),the number of patients with abdominal distension was decreased ( x2 =4.84,P =0.025 ).Compared with those of C group,defecation time was earlier,number of bowel movement was increased with soft feces in patients of T group.The serum levels of GAS in T group on PBD 3,7,14 [ (92 ±26),(95 ± 16),(98 ±18) ng/L] were significantly higher than those in C group [ (80 ± 15),(75 ± 17),(79 ± 13) ng/L,with t value respectively 15.352,22.951,19.263,P values all below 0.01 ].The serum levels of MTL in T group on PBD 3,7,14 [ (246 ±80),(299 ±76),(300 ± 100) ng/L] were significantly higher than those in C group [(189 ±44),(203 ±64),(200 ±67) ng/L,with t value respectively 14.173,19.294,26.298,P values all below0.01].The serum levels of ET in T group on PBD 3,7,14 [(0.398 ±0.035),(0.373 ± 0.005 ),(0.238 ± 0.019) EU/mL] were significantly lower than those in C group [(0.493 ±0.043),(0.501 ±0.045),(0.423 ±0.099) EU/mL,with t value respectively 6.213,9.153,15.134,P ＜0.05 orP ＜0.01 ].The serum levels of DAO in T group on PBD 3,7 [ (3.0 ±0.4),(2.9 ± 0.5 ) U/mL] were significantly lower than those in C group [ ( 3.9 ± 0.5 ),( 3.6 ± 0.6 ) U/mL,with t value respectively 3.982,4.236,P values all below 0.05 ],and there was no obvious difference between T and C groups on PBD 14 ( t =1.762,P ＞0.05).Conclusions Rhubarb can protect intestinal mucosal barrier in patients with severe burn through increasing secretion of gastrointestinal hormones and promoting restoration of gastrointestinal motility.
