黄连素对胃切除术后病人胃肠激素的影响

Effects of Rhizoma Coptidis on gut hormones after subtotal gastrectomy

目的观察黄连素联合早期肠内营养对胃大部切除术病人胃肠激素的影响。方法将2008年8月至2010年8月拟择期行胃大部切除术的50例病人分为4组：肠外营养组（PN）12例，黄连素联合肠外营养组（RPN）12例，早期肠内营养组（EN）13例，黄连素联合肠内营养组（REN）13例。PN及EN组于术后第1～6天分别给予PN或EN支持治疗。RPN及REN组病人在以上基础上另分别于术前3d及术后6d应用黄连素。观察4组病人术前、术后第1、7天胃泌素（GAS）、胃动素（MTL）、胆囊收缩素（CCK）水平及住院时间、拔除胃管时间。结果50例胃大部切除病人术后第l天血GAS、MTL和CCK水平较术前显著下降（P〈0．01），术后第7天恢复至术前水平；术后第7天EN组血浆MTL、CCK水平显著高于PN组（P〈0．05或P〈0．叭），REN组变化更为明显（P〈0．01）。REN组GAS水平较PN组升高（P〈0．05）。REN、EN组病人与RPN与PN组比，住院时间明显减少（P〈0．05）。结论胃大部切除术后应用肠内营养能增加病人血浆MTL和CCK水平，有助于促进残胃动力功能的恢复，促进胃肠道消化和吸收，而联合黄连素可使效果更为显著，有利于病人早日康复。

Objective To observe the effects of Rhizoma Coptidis combined with early enteral nutrition on gut hormones after subtotal gastrectomy. Methods Fifty patients undergoing elective subtotal gastrectomy were divided into four groups as follows.. 12 patients were treated with total parenteral nutrition （PN）, 12 patients with Rhizoma Coptidis combined with parenteral nutrition （RPN）, 13 patients with early enteral nutrition （EN） ,and 13 patients with Rhizoma Coptidis combined with early EN （REN）. From the first day after operation to the seventh day, patients received either EN （EN groups） or PN （PN groups） supportive therapy. The patients in REN and RPN groups received Rhizoma Coptidis from 3rd day before operation to 7th day after operation. Gastrin （GAS）, motilin （MTL） and cholecystokinin （CCK） were measured on the day before operation, the first day and the seventh day after operation. Hospital stay and time of tube removal were also observed. Results Compared to the preoperative levels, the GAS, MTL and CCK levels of all 50 patients were decreased significantly on the first day after subtotal gastrectomy （P〈0. 01）, but returned to the preoperative levels one week later. On the seventh day after subtotal gastrectomy, the MTL and CCK levels in EN group were higher than those in PN group （P〈0. 05 or P〈0. 01） ,more significantly in REN group. GAS levels were significantly higher in PEN group than in PN group （P〈0. 05）. The hospital stay in REN and EN groups was significantly shortened as compared with PN and RPN group （P〈0. 05）. Conclusion EN can promote the recovery of gastrointestinal motility, digestion and absorption, and EN combined with Rhizoma Coptidis can make more significant benefit in patients with early recovery.