环氧酶抑制剂对脓毒症患者代谢反应的影响

Effect of cyclooxygenase inhibitor on metabolic response in septic patients

目的探讨环氧酶抑制剂对脓毒症时代谢反应的影响。方法将２０例腹腔感染引起的脓毒症患者随机分成两组，消炎痛组１０例，应用消炎痛肛栓剂，每次５０ｍｇ，８小时１次，连续７天；对照组１０例，按同样方法给予安慰剂。在用药前后分别测定两组患者体重、血清白蛋白、Ｃ反应蛋白、皮质醇、肿瘤坏死因子（ＴＮＦ），每日测定体温和尿中尿素氮排出量。结果两组患者年龄、性别、原发病和即往健康状况评分（ＡＰＡＣＨＥⅡ）无显著性差异。与对照组相比，消炎痛组每日体温显著下降，血清ＴＮＦ水平显著降低，尿中尿素氮排出量显著减少。血清白蛋白在消炎痛组用药后明显高于对照组。结论脓毒症患者应用环氧酶抑制剂可以显著减轻发热等炎症反应，降低血清ＴＮＦ水平，减少蛋白质分解代谢。

Objective To observe the effect of cyclooxygenase inhibitor on septic metabolism. Method 20 patients with sepsis caused by intra abdominal infection were randomly divided into two groups.The indomethacin group received the suppository of indomethacin(50 mg,1/8h,7 days)in the rectum and the control group received placebo. Body weight and serum concentrations of albumin,c reactive protein(C RP),cortisol and tumor necrosis factor(TNF)were measured before and after the study.Temperature was taken, and urea nitrogen excretion in the urine was determined every day during the study period. Result No differences were seen in age,sex,primary disease and APACHE Ⅱ score between the two groups.When compared with the control group,the daily temperature and the serum TNF levels were lowered and urea nitrogen excretion in urine was decreased in the indomethacin group( P <0.05 or 0.01).The concentration of serum albumin in the indomethacin group was significantly higher than in the control group at the end time of the study. Conclusion The use of cyclooxygenase inhibitor in septic patients may decrease the inflammatory response,such as fever,the serum TNF level and the excretion of urea nitrogen in urine.The indomethacin suppository used in rectum is safe,cheap and effective as one of the means of metabolic intervention in sepsis.