卡巴胆碱治疗创伤和感染后胃肠功能障碍78例

Treatment of severe trauma-or infection-induced gastrointestinal dysfunction with carbachol:an analysis of 78 cases

目的:研究卡巴胆碱治疗创伤和感染后胃肠功能障碍的有效性和安全性.方法:选取2007-02/2008-02唐山市3家三级医院ICU重症患者140例,随机分为卡巴胆碱组(n=78)和莫沙比利组(n=62).观察患者治疗前(0h)、治疗后24,48,72h及7d的肠管积气、积液、胃肠功能评分、临床总有效率和血清二胺氧化酶(DAO)、D-乳酸和内毒素水平变化.结果:与莫沙比利组比较,治疗后卡巴胆碱组患者肠管积气/积液明显改善(P<0.05),第7天胃肠功能评分明显降低(P<0.05),临床总有效率显著提高(62.8%vs43.6%,P<0.05).血清DAO、D-乳酸和内毒素水平第7天均明显低于莫沙比利组(P<0.05).结论:卡巴胆碱可以降低创伤和感染重症患者血清DAO、D-乳酸和内毒素水平,改善肠积气,降低胃肠功能评分,具有胃肠功能保护作用.

AIM： To investigate the efficacy of carbachol in the treatment of gastrointestinal dysfunction induced by severe trauma or infection. METHODS： One hundred and forty intensive care unit （ICU） patients selecting from three hospitals in Tangshan City were randomly divided into two groups： carbachol treatment group （n = 78） and mosapride citrate treatment group （n = 62）. Intestinal pneumatosis and hydrops, gastrointestinal dysfunction scores and overall response rate were observed. The activity of plasma diamine oxidase （DAO） and the content of serum D-lactic acid were determined at 0, 24, 48 and 72 hours and on day 7 after treatment, respectively. RESULTS： Compared to the mosapride citrate treatment group, patients in the carbachol treatment group showed a significant improvement in intestinal pneumatosis and hydrops （P 〈 0.05）, a significant decrease in gastrointestinal dysfunction scores （P 〈 0.05）, an obvious increase in overall response rate （43.6% vs 62.8%, P 〈 0.05）, as well as a significant decline in the activity of DAO and the contents of serum D-lactic acid and endotoxin on day 7 after treatment （P 〈 0.05）. CONCLUSION： Carbachol can decrease the activity of plasma DAO and the levels of serum D-lactic acid and endotoxin, and improve intestinal function in patients with severe trauma- or infection-induced gastrointestinal dysfunction.