中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2013年
11期
1474-1477
,共4页
黄疸,阻塞性%引流术%肠黏膜/病理生理学%毒血症%全身炎症反应综合征
黃疸,阻塞性%引流術%腸黏膜/病理生理學%毒血癥%全身炎癥反應綜閤徵
황달,조새성%인류술%장점막/병리생이학%독혈증%전신염증반응종합정
Jaundice,obstructive%Drainage%Intestinal mucosa/physiopathology%Toxemia%Systemic inflammatory response syndrome
目的 从肠黏膜屏障功能的角度观察胆道内、外引流术对胆道梗阻的疗效,以探讨胆道内、外引流术在临床应用中的优缺点.方法 胆道良恶性梗阻,胆红素明显增高患者40例,分组行鼻胆管外引流术(ENBD)和胆道塑料支架内引流术(ERBD),动态观察术后患者血清二胺氧化酶(DAO)、内毒素和TNF-α含量的变化,分析比较两种引流术对肠黏膜屏障功能的影响及全身炎症反应的改变.结果 ERBD与ENBD组术后血胆红素,γ-谷氨酰转肽酶(γ-GT),碱性磷酸酶(ALP)均呈进行性下降.ERBD与ENBD组术后1 d DAO、血内毒素、TNF-α比较差异无统计学意义(P＞ 0.05),术后3d和7d,ENBD组DAO、血内毒素、TNF-α值明显高于ERBD组,差异有统计学意义(P＜0.05).结论 (1)ERBD与ENBD对解除胆道梗阻、引流胆汁方面均有较好效果.(2)ENBD对改善肠黏膜屏障有一定局限性,而且长时间外引流可能导致肠黏膜屏障损伤的加重,并由此引发肠源性内毒素血症和全身炎症反应.
目的 從腸黏膜屏障功能的角度觀察膽道內、外引流術對膽道梗阻的療效,以探討膽道內、外引流術在臨床應用中的優缺點.方法 膽道良噁性梗阻,膽紅素明顯增高患者40例,分組行鼻膽管外引流術(ENBD)和膽道塑料支架內引流術(ERBD),動態觀察術後患者血清二胺氧化酶(DAO)、內毒素和TNF-α含量的變化,分析比較兩種引流術對腸黏膜屏障功能的影響及全身炎癥反應的改變.結果 ERBD與ENBD組術後血膽紅素,γ-穀氨酰轉肽酶(γ-GT),堿性燐痠酶(ALP)均呈進行性下降.ERBD與ENBD組術後1 d DAO、血內毒素、TNF-α比較差異無統計學意義(P＞ 0.05),術後3d和7d,ENBD組DAO、血內毒素、TNF-α值明顯高于ERBD組,差異有統計學意義(P＜0.05).結論 (1)ERBD與ENBD對解除膽道梗阻、引流膽汁方麵均有較好效果.(2)ENBD對改善腸黏膜屏障有一定跼限性,而且長時間外引流可能導緻腸黏膜屏障損傷的加重,併由此引髮腸源性內毒素血癥和全身炎癥反應.
목적 종장점막병장공능적각도관찰담도내、외인류술대담도경조적료효,이탐토담도내、외인류술재림상응용중적우결점.방법 담도량악성경조,담홍소명현증고환자40례,분조행비담관외인류술(ENBD)화담도소료지가내인류술(ERBD),동태관찰술후환자혈청이알양화매(DAO)、내독소화TNF-α함량적변화,분석비교량충인류술대장점막병장공능적영향급전신염증반응적개변.결과 ERBD여ENBD조술후혈담홍소,γ-곡안선전태매(γ-GT),감성린산매(ALP)균정진행성하강.ERBD여ENBD조술후1 d DAO、혈내독소、TNF-α비교차이무통계학의의(P＞ 0.05),술후3d화7d,ENBD조DAO、혈내독소、TNF-α치명현고우ERBD조,차이유통계학의의(P＜0.05).결론 (1)ERBD여ENBD대해제담도경조、인류담즙방면균유교호효과.(2)ENBD대개선장점막병장유일정국한성,이차장시간외인류가능도치장점막병장손상적가중,병유차인발장원성내독소혈증화전신염증반응.
Objective To compare the effect of endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) on intestinal mucosal barrier function of patients with obstructive jaundice in clinical practice.Methods Forty patients with significant jaundice due to obstructive disorders of biliary tract and 20 health volunteers as controls were recruited.At the baseline,serum diamine oxidase (DAO) was measured with ultraviolet spectrophotometer,while endotoxin and tumor necrosis factorα (TNF-α) were determined with endotoxin detector and enzyme-linked immunosorbent assay (ELISA)kits,respectively.Forty patients were then divided randomly into ENBD and ERBD groups (n =20 patients per group).Dynamic changes in serum DAO,endotoxin and TNF-α were observed postoperatively.Results In the patients with obstruction of biliary tract,higher serum bilirubin,γ-glutamyl transpeptidas (γ-GT),alkaline phosphatase (ALP),DAO,endotoxin,and TNF-α were found preoperatively relative to those in health control (P ＜ 0.05).After operation,ERBD and ENBD had comparable effect on improving serum bilirubin,γ-GT and ALP,while serum DAO,endotoxin and TNF-α in each group were dramatically decreased.In day 1 after operation,there was no significant difference in serum DAO,endotoxin and TNF-α between two groups.However,in day 3 and 7 after operation,serum DAO,endotoxin and TNF-α in ENBD group were significantly higher than those in ERBD group (P ＜ 0.05).Conclusions It was suggested that ERBD and ENBD have comparable effects on removing obstruction of biliary tract and draining bile.However,ERBD might have greater benefits than ENBD in improving intestinal mucosal barrier function,and thus would be more beneficial in preventing systemic inflammatory response.
