CAJ | 학술논문

目的探讨卡巴胆碱对急诊创伤后肠屏障功能障碍患者心肌的保护作用.方法选择70例急诊创伤后肠屏障功能障碍综合征的患者完全随机分为卡巴胆碱组(37例)和莫沙必利组(33例),监测患者第1、7天外周血二胺氧化酶活性、嗜中性多形核粒细胞CD11b+/CD18的表达率、左心室射血分数及肌酸激酶同工酶峰值,观察临床疗效.结果治疗后7d,卡巴胆碱组有效26例(70.3％),死亡7例(18.9％);莫沙必利组有效15例(45.5％),死亡13例(39.4％).卡巴胆碱组有效率优于莫沙必利组,差异有统计学意义(x2=4.43,P＜ 0.05).卡巴胆碱组治疗第1天血二胺氧化酶、CD11b+和CD18分别为(4.8±0.5)kU/L、(30.6±3.6)％、(75.8±3.6)％,第7天分别为(3.2±0.5) kU/L、(14.9±2.2)％、(53.7±2.4)％;莫沙必利组治疗第1天血二胺氧化酶、CD11b+和CD18分别为(4.7±0.3)kU/L、(31.1±2.9)％、(74.6±2.7)％,第7天分别为(3.9±0.5)kU/L、(28.9±1.6)％、(72.5±4.1)％,治疗第7天卡巴胆碱组患者血二胺氧化酶水平、嗜中性多形核粒细胞CD11b及CD18阳性表达率均低于入组第1天及莫沙必利组,差异均有统计学意义(均P＜0.05).2组患者入组时肌酸激酶同工酶差异无统计学意义,而卡巴胆碱组肌酸激酶同工酶峰值明显低于莫沙必利组[(60±19) U/L比(79±18) U/L],差异有统计学意义(P＜0.05);2组患者入组时左心室射血分数差异无统计学意义,卡巴胆碱组左心室射血分数峰值高于莫沙必利组[(60±7)％比(55±7)％],差异有统计学意义(P＜0.05).结论卡巴胆碱通过降低急诊创伤后肠屏障功能障碍患者肠道缺血再灌注损伤、减少活性炎症介质释放、促进肠蠕动,从而减轻心肌损伤,保护远隔脏器-心脏的功能.
목적 탐토잡파담감대급진창상후장병장공능장애환자심기적보호작용.방법 선택70례급진창상후장병장공능장애종합정적환자완전수궤분위잡파담감조(37례)화막사필리조(33례),감측환자제1、7천외주혈이알양화매활성、기중성다형핵립세포CD11b+/CD18적표체솔、좌심실사혈분수급기산격매동공매봉치,관찰림상료효.결과 치료후7d,잡파담감조유효26례(70.3％),사망7례(18.9％);막사필리조유효15례(45.5％),사망13례(39.4％).잡파담감조유효솔우우막사필리조,차이유통계학의의(x2=4.43,P＜ 0.05).잡파담감조치료제1천혈이알양화매、CD11b+화CD18분별위(4.8±0.5)kU/L、(30.6±3.6)％、(75.8±3.6)％,제7천분별위(3.2±0.5) kU/L、(14.9±2.2)％、(53.7±2.4)％;막사필리조치료제1천혈이알양화매、CD11b+화CD18분별위(4.7±0.3)kU/L、(31.1±2.9)％、(74.6±2.7)％,제7천분별위(3.9±0.5)kU/L、(28.9±1.6)％、(72.5±4.1)％,치료제7천잡파담감조환자혈이알양화매수평、기중성다형핵립세포CD11b급CD18양성표체솔균저우입조제1천급막사필리조,차이균유통계학의의(균P＜0.05).2조환자입조시기산격매동공매차이무통계학의의,이잡파담감조기산격매동공매봉치명현저우막사필리조[(60±19) U/L비(79±18) U/L],차이유통계학의의(P＜0.05);2조환자입조시좌심실사혈분수차이무통계학의의,잡파담감조좌심실사혈분수봉치고우막사필리조[(60±7)％비(55±7)％],차이유통계학의의(P＜0.05).결론 잡파담감통과강저급진창상후장병장공능장애환자장도결혈재관주손상、감소활성염증개질석방、촉진장연동,종이감경심기손상,보호원격장기-심장적공능.
Objective To explore protection of carbachol for myocardium in patients with intestinal barrier dysfunction induced by emergency trauma.Methods Seventy patients after trauma with a definite diagnosis of multiple organ dysfunction syndrome in intensive care unit were included,were randomly divided into the carbachol group (n =37) and mosapride citrate group(n =33).Diamine oxidase activity,expressions of CD11b + and CD18 on polymor phonuclear meutrophilc(PMN) in peripheral blood and left ventricular ejection fraction(LVEF) were detected on the 1st and 7th day,as well as the peak contents of creatine kinase-MB (CK-MB).Clinical effects were observed.Results After treatment of 7 days,26 cases(70.3％) in carbachol group were effective in treatment,7 cases(18.9％)died,while 15 cases(45.5％) in mosapride citrate group were effective in treatment,13 cases(39.4％) died.Carbachol group showed a higher effective rate than the mosapride citrate group,thus the scores had statistical difference(x2 =4.43,P ＜ 0.05).On the 1 st day,diamine oxidase,CD11b + and CD18 in carbachol group was(4.8 ± 0.5) kU/L,(30.6 ± 3.6) ％,(75.8 ± 3.6) ％,on 7th day was (3.2 ± 0.5) kU/L,(14.9 ± 2.2)％,(53.7 ± 2.4)％.On the 1 st day diamine oxidase,CD11b + and CD18 in mosapride citrate group was(4.7 ±0.3)kU/L,(31.1 ±2.9)％,(74.6 ±2.7)％,on 7th day was(3.9 ±0.5) kU/L,(28.9 ± 1.6)％,(72.5 ± 4.1)％.After treatment of 7 days,diamine oxidase,CD11b + and CD18 in carbachol group was lower than the inclusion spot and mosapride citrate group,thus the scores had statistical difference(P ＜0.05).CK-MB had no statistical difference at the moment of entering between the two groups.But in carbachol group,the peak contents of CK-MB was lower than that of mosapride citrate group[(60 ± 19)U/L vs (79 ± 18)U/L],scores had statistical difference(P ＜ 0.05).Left ventricular ejection fraction had no statistical difference at the moment of entering the group between the two groups.But in carbachol group,the peak was higher than that of mosapride citrate group[(60-± 19) U/L vs (79 ± 18) U/L],thus the score had statistically difference (P ＜ 0.05).Conclusions To the patients of intestinal barrier dysfunction induced by emergency trauma,by lessening the ischemic/reperfusion injury,inhibiting the production of inflammatory cytokines in vivo and promoting peristalsis of intestinal tract.Carbachol can loosen the myocardium injury and protect remote organ-heart function.