大黄对危重症患者胃肠粘膜血流灌注的影响

Effects of rhubarb on gastrointestinal perfusion in critical illness

目的 研究大黄对胃肠粘膜血流灌注的影响。方法 选用激光多普勒血流监测仪和胃肠粘膜内pH(pHi)值作为评估失血性休克动物模型和脓毒症患者胃肠粘膜血流灌注的指标。结果 动物实验显示 :失血性休克大鼠尽管予以充分复苏 ,但胃肠粘膜的血流量仅是对照组的一半 ,给予大黄治疗 (5 0mg/kg)后 ,胃肠粘膜的血流量接近正常对照组 (P <0 0 1VS休克组 )。此外正常大鼠喂服大黄后胃肠粘膜的血流量显著提高 (P <0 0 1VS正常对照组 )。临床研究显示 :脓毒症患者胃和直肠粘膜内pHi明显低于对照组 (P <0 0 0 1)。多器官功能障碍综合征 (MODS)患者 ,其pHi显著低于非MODS患者 (P <0 0 0 1VS治疗前 )。另外 ,大黄对应激性胃粘膜病变有效率达 73%。结论 大黄能提高失血性休克大鼠和危重症患者胃肠粘膜内血流灌注。

Objective To study the effect of rhubarb on gastrointestinal perfusion in hemorrhagic shocked rats and critical illness.Methods Animal study: SD rats were anesthetized with intraperitoneal sodium pentobarbital(50 mg/kg). The animal were bled.Blood pressure reduced to 5.32 kPa and maintained for 120 min. They were resuscitated at the end of shock by reinfusing all of the shed blood. The rats were divided into four groups: normal control, shock group, therapeutic group(shocked rats were treated with rhubarb 50 mg/kg at the end of shock) and rhubarb group (normal controlled rats were treated with rhubarb). The gastrointestinal perfusion was evaluated by Laser Doppler and intramural pH (pHi).Results Animal study: Although the shocked rats were resuscitated completely, their gastrointestinal perfusion was much lower than that of control( P <0.01). Rhubarb could dramatically improve the gut perfusion. There was significant difference between shocked rats and rhubarb treated rats( P <0.01). Furthermore, rhubarb also increase the gastrointestinal perfusion in normal controlled rats. Chinical study: The septic patients have much lower intramural pH value (pHi) compared with control. Whereas rhubarb could obviously upgrade gastrointestinal pHi( P <0.001 VS pretreatment). In addition, rhubarb also had a good effect on gastric bleeding caused by stress ulcer. Conclusions The rhubarb could improve the gastrointestinal blood perfusion in shocked rats and critically ill patients. [