奥曲肽治疗肠源性内毒素血症的临床研究

Clinical study of octreotlde in the treatment of intestinal endotoxemia

目的观察奥曲肽持续静脉泵入在肠源性内毒素血症患者中的治疗效果。方法肠梗阻非手术治疗患者80例，34例常规治疗者设为I组,46例常规治疗联合奥曲肽24h持续静脉泵入者设为Ⅱ组，于治疗前和治疗后24h、48h．4d检测白细胞计数（WBC）、二胺氧化酶（DAO）、D-乳酸（D-LA）、内毒素含量。结果两组治疗后48hWBC、DAO、D—LA、内毒素含量均达到峰值，两组治疗后24hWBC、DAO、D-LA、内毒素含量比较差异无统计学意义（P〉0．05）。Ⅱ组治疗后48h、4dWBC、DAO、D．LA、内毒素含量均低于I组，治疗后48h比较差异有统计学意义[（18．40±0．10）×109／L比（20．60±2．36）×10^9．／L、（6．12±1．02）kU／L比（8．02±1．54）kU/L、（2．14±0．21）mg／L比（3．34±0．04）mg／L、（1．65±0．16）kEU／L比（2．23±0．36）kEU／L]（P〈0．01），治疗后4d比较差异无统计学意义（P〉0．05）。II组患者治疗后48h体温、胃肠减压量、肛门排气时间分别为（37．60±3．01）℃、（320．00±76．14）ml／d、（54．00±0．94）h，均优于I组的（38．50±2．21）℃、（500．00±80．32）ml／d、（68．00±1．02）h，差异有统计学意义（P〈0．01）。结论持续静脉泵入奥曲肽能有效保护肠黏膜屏障功能，改善肠黏膜通透性，减少肠内菌群移位，抑制肠源性内毒素血症的发生、发展，为奥曲肽在肠源性内毒素血症患者中的应用提供新的证据支持。

Objective To observe the clinical effect of continuous intravenous pumping of octreotide in the treatment of intestinal endotoxemia. Methods Eighty patients with intestinal obstruction and non-surgical treatment were divided into group I with 34 cases who received conventional-treatment and group I1 with 46 cases who received conventional-treatment combined with octreotide 24 h continuous intravenous pumping. White bloocl cell count （WBC）,diamine oxidase （DAO）,D-lactic acid （D-LA） and endotoxin were detected before treatment and at 24 h,48 h,4 d after treatment. Results The content of WBC, DAO, D-LA and endotoxin in two groups all reached peak at 48 h after treatment. The difference of the content of WBC, DAO, D-LA and endotoxin between two groups had no statistical significance at 24 h after treatment （P 〉0.05）. The content of WBC,DAO,D-LA and endotexin of group II at 48 h and 4 d after treatment were lower than those of group I . And the difference at 48 h after treatment had statistical significance[ （ 18.40±0.10）×10^9/L vs. （20.60±2.36）×10^9/L, （6.12± 1.02） kU/L vs.（8.02± 1.54） kU/L, （2.14 ±0.21） mg/L vs. （3.34±0.04） mg/L, （1.65 ±0.16） kEU/L vs. （2.23 ±0.36） kEU/L] （P 〈0.01）. While the difference at 4 d after treatment had no statistical significance（P〉 0.05）. Body temperature at 48 h after treatment, gastrointestinal decompression capacity, anus exhaust time of group 11 were （37.60 ±3.01 ） ℃, （320.00 ±76.14） ml/d, （54.00 ±0.94） h respectively,and they all were superior to those of group I m （38.50 ±2.21 ） ℃, （500.00 ± 80.32） mud, （68.00 ±1.02） h ] （P 〈 0.01 ）. Conclusions Continuous intravenous pumping of octreotide can effectively protect the intestinal mueosal barrier function,improve intestinal permeability, reduce the transloeation of intestinal flora,inhibit the incidence and development of enterogenous endotoxemia. And it provides new evidence to support the clinical application of oetreotide in patients with intestinal endotoxemia.