大黄对严重烧伤患者胃肠动力及肠黏膜屏障的影响

Influence of rhubarb on gastrointestinal motility and intestinal mucosal barrier in patients with severe burn

目的观察大黄对严重烧伤患者胃肠动力及肠黏膜屏障的影响。方法选择太钢总医院2009年12月-2010年12月收治的30例严重烧伤患者，按随饥数字表法分为对照组14例、治疗组16例．所有患者均于伤后48h内入院，入院后6h内留置鼻胃管。治疗组患者入院后6h开始鼻饲大黄10g，3次／d，并口服L-谷氨酰胺颗粒5g，3次／d；入院后24h开始进行肠内营养。对照组患者不使用大黄，其余各项营养支持治疗措施（口服L-谷氨酰胺颗粒、给予肠内营养）均与治疗组相同：观察2组患者用药后腹胀、对肠内营养的耐受、24h肠鸣音恢复、排便等胃肠功能一般情况。于2组患者伤后3、7、14d清晨取静脉血分离血清，放射免疫法测定胃泌素水平，ELISA法测定胃动素水平，鲎试剂动态浊度法测定内毒素水平，酶学分光光度法测定二胺氧化酶活性。计数资料数据采用x2检验，计量资料数据采用￡检验。结果与对照组比较，治疗组患者的腹胀发生例数较少（x2=4．84．P=0．025），对肠内营养耐受例数及24h肠鸣音恢复例数较多（x2=5．01，P=0．031；x2=4．84，P=0．028）．排便时间明显提前．排便次数增加，大便较软。治疗组患者伤后3、7、14d血清胃泌素水平分别为（92±26）、（95±16）、（98±18）ng／L，均高于对照组[（80±15）、（75±17）、（79±13）ng／L，t值分别为15．352、22．951、19．263，P值均小于0．01]，治疗组伤后3、7、14d血清胃动素水平分别为（246±80）、（299±76）、（300±100）ng／L，明显高于对照组[（189±44）、（203±64）、（200±67）ng／L，t值各为14．173、19．294、26．298，P值均小于0．01]。治疗组伤后3、7、14d血清内毒素水平分别为（0．398±0．035）、（0．373±0．005）、（0．238±0．019）EU／mL，均低于对照组[（0．493±0．043）、（0．501±0.045）、（0．423±0．099）EU／mL，t值分别为6．213、9．153、15．134． P〈0．05或P〈0．01]。治疗组伤后3、7d血清二胺氧化酶活性分别为（3．0±0．4）、（2．9±0．5）U／mL，均低于对照组[（3．9±0．5）、（3．6±0．6）U／mL，t值分别3．982、4．236，P值均小于0．05]；伤后14d2组水平接近（t=1．762，P〉0．05）。结论大黄能增加烧伤患者胃肠激素水平，促进其胃肠动力恢复，从而保护患者胃肠黏膜屏障功能。

Objective To observe the influence of rhubarb on gastrointestinal motility and intestinal mueosal barrier in patients with severe burn. Methods Thirty patients with severe burn admitted to our buru wards within 48 hours after burn injury from December 2009 to December 2010 were divided into therapeutic group （ T, treated with 10 g rhubarb by nasal feeding and 5 g L-glutamine by oral administration beginning from 6 hours after＂ admission, three, times per day, anti also given enteral nutrition beginning from 24 hours after＂ admission, n = 16） and control group （ C, received the same treatment as used in T group but without rhubarb, n = 14） according to the random number table. Gastrointestiual function indexes including restoration of bowel sound within 24 hours, abdominal distension, tolerance to enteral nutrition, and defecation were observed after treatment. The serum samples were harvested on post burn day （PBD） 3, 77 14 for determination of the levels of gastrin （GAS） by radioimmunoassay, motilin （MTL） by enzyme-linked immu- nosnrbent assay, diamine oxidase （DAO） by enzyme speetrophotomelry, and endotoxin （ET） by kinetic tur- bidimetric assay with TAL. Data were processed with t test and chi-square test. Results Compared with those in C group, the numbers of patients with restoration of bowel sound within 24 hours and tolerance to enteral nutrition in T group were increased （ with x2 value respectively 5.01, 4.84, P values all below 0.05 ） , the number of patients with abdominal distension was decreased （ X2 = 4.84, P = 0. 025 ）. Compared with those of C group, defecation time was earlier, number of bowel movement was increased with soft feces in patients oft group. The serum levels of GAS inTgroup on PBD 3, 7, 14 [（92±26）, （95 ±16）, （98 ± 18） ng/L] were significantly higher than those in C group [ （80 ± 15） , （75 ± 17） , （79 ± 13） ng/L, with t value respectively 15. 352, 22. 951, 19. 263, P values all below 0.01 ]. The serum levels of MTL in T group on PBD 3, 7, 14 [ （246 ±80）, （299 ±76）, （300 ± 100） ng/L] were significantly higher than those in C group [（189 ±44）, （203 ±64）, （200 ±67） ng/L, with t value respectively 14. 173, 19. 294, 26. 298, P values all below 0.01]. The serum levels of ET in T group on PBD 3, 7, 14 [（0.398 ± 0. 035）, （0.373 ± 0. 005）, （0. 238 ± 0. 019） EU/mL] were significantly lower than those in C group [（0.493 ±0.043）, （0.501 ±0.045）, （0.423 ±0.099） EU/mL, with t value respectively 6. 213, 9. 153, 15. 134,P 〈0.05 or P 〈0.01]. The serum levels of DAO in T group onPBD3, 7 [（3.0±0.4）, （2.9 ±0.5） U/mL] were significantly lower than those in C group [（3.9 ±0.5）, （3.6 ±0.6） U/mL, with t value respectively 3. 982, 4. 236, P values all below 0.051 , and there was no obvious difference between T and C groups on PBD 14 （ t = 1. 762, P 〉 0.05）. Conclusions Rhubarb can protect intestinal mueosal barrier in patients with severe burn through increasing secretion of gastrointestinal hormones and promoting restoration of gastrointestinal motility.