参附注射液对严重创伤患者胃肠屏障及全身炎性反应的影响

Influence of shenfu injection on intestinal mucosal barrier and SIR in severe multiple trauma patients

目的观察参附注射液（SF）对严重创伤患者胃肠屏障及全身炎性反应的影响并探讨其机制。方法将76例创伤严重度评分（ISS）〉20分严重多发伤患者随机分为治疗组38例和对照组38例，对照组行常规治疗，治疗组在常规治疗基础上加用参附注射液，监测两组治疗前后不同时间患者休克指数变化，测定胃黏膜pH（pHi）、血浆D-乳酸、肿瘤坏死因子-α．（TNF—α）、白细胞介素-6（IL-6）水平变化。结果两组患者治疗前休克指数监测及胃pHi、血浆D-乳酸、TNF-仅、IL-6水平比较差异均无统计学意义（P〉0．05）；治疗后休克指数在12、24、48h，治疗组与对照组比较均显著改善（P〈0．05）；pHi在24、48、72h治疗组与对照组比较均显著升高（P〈0．05）；血浆D-乳酸、TNF-α及IL-6水平在第3、7天则均显著低于对照组（P〈0．05）。结论对严重多发伤患者应用SF对胃肠黏膜屏障损伤具有保护作用，抑制全身炎性反应程度。其机制是SF能迅速恢复血流动力学稳定，改善微循环状态，改善胃肠道黏膜的灌注和氧合、保护肠黏膜细胞结构和功能、阻止内毒素移位及炎性介质释放。

Objective To observe the influence of Shenfu （SF） injection on intestinal mucosal barrier and systemic inflammatory response （SIR） in severe multiple trauma patients and study its mechanism. Methods Seventy -six multiple trauma patients [ injury severity score （ISS） 〉 20] were selected and assigned randomly to SF treatment group（38 cases） or control group（38 cases）. All patients were treated with classical therapy. Meanwhile, patients in SF group were infused with Shenfu （SF） injection. Shock index were measured at 12, 24, 48, 72 h after trauma, and the gastric intramucosal pH value（pHi）, blood samples were collected 1, 3, 7 d after trauma for plasma levels of D - lactate, and the plasma con- tents of TNF - α, IL - 6 were determined. Results At the beginning of SF treatment, there were no sig- nificant differences in gastric PHi, D -lactate,TNF -α and IL -6 between the two groups（ P 〉 O. 05）. In SF group, shock index at 12, 24, 48 h after trauma and PHi at 24, 48, 72 h were significantly different from that in control group （ P 〈 0.05）. Plasma levels of D - lactate and the plasma contents of TNF - α, IL -6 3,7 d after trauma decreased significantly in SF group than that in control group （ P 〈0. 05）. Conclusions SF can protect gastrointestinal and inhibit SIR in severe multiple trauma patients, its mechanism may be that SF rapid restore hemodynamic stability, improve microcirculation and can improve gastrointestinal mucosal perfusion and oxygenization, protect structure of mucosal cell and its barrier function, inhibit inflammatory mediators release.