大黄对危重症患者胃肠道的保护作用

The protective effect of rhubarb on gut in critical illness

目的：研究大黄对危重症患者胃肠功能衰竭的防治作用，并探讨其机制。方法：将严重创伤、休克、感染等所致脓毒症患者随机分为大黄预防组和非大黄预防组，将非大黄预防组中出现的应激性胃肠粘膜病变和中毒性肠麻痹的患者作为大黄治疗组的研究对象。观察预防组和非预防组患者胃肠道并发症的发生率，并研究大黄对多器官功能障碍综合征（ＭＯＤＳ）患者血浆内肿瘤坏死因子 α（ＴＮＦ α）、白介素 ６（ＩＬ ６）和内毒素的影响。结果：大黄预防组患者应激性胃肠粘膜病变、中毒性肠麻痹和ＭＯＤＳ的发生率明显低于非预防组，大黄对应激性胃肠粘膜病变的有效率达７１．２％ ，中毒性肠麻痹的缓解率达７６．１％ ，其中有５２．２％ 的患者恢复了胃肠营养。另外，大黄能提高危重症患者胃肠粘膜内ｐＨ值，改善胃肠粘膜血流灌注，明显降低ＭＯＤＳ患者血浆内ＴＮＦ α、ＩＬ ６ 和内毒素含量。结论：大黄能预防和治疗危重症患者胃肠功能衰竭，改善胃肠粘膜的血流灌注，清除患者血浆内炎性介质。

Objective:To investigate the effect of rhubarb on the gut in critical illness.Methods:The septic patients after trauma,shock and infection were selected in this study.All patients were randomly divided into preventive group and nonpreventive group.The patients were treated with rhubarb at a dose of 25 mg/kg,per 8 hours in preventive group.Except rhubarb,the other therapies were similar between the two groups.The intramural pH and plasma tumor necrosis factorα(TNFα),interleukin6(IL6) as well as endotoxin levels were measured in patients.Results:The incidence of stress ulceration,gastrointestinal paralysis and multiple organ dysfunction syndrome were obviously lower in preventive group than that in nonpreventive group.Rhubarb had good curative effects on stress ulceration and toxic gastrointestinal paralysis caused by sepsis.Furthermore,rhubarb could improve the gastrointestinal blood perfusion and reduce the plasma concentrations of TNFα,IL6 and endotoxin.Conclusions:Rhubarb has a good curative effect on gastrointestinal failure and also can prevent gut failure in critical illness.