大黄对危重症患者系统炎症反应治疗作用的临床研究

Clinical study of rhubarb against systemic inflammatory response in critical illness

目的 :研究大黄的抗炎作用机制 ,并观察不同给药途径对大黄药理作用的影响。方法 :对脓毒症合并中毒性肠麻痹的 ICU内危重症患者 ,观察大黄鼻饲和保留灌肠对中毒性肠麻痹的缓解率、循环血内肿瘤坏死因子 α(TNFα)浓度及其基因表达的影响。结果 :鼻饲组 :大黄治疗后 2 4、48和 72小时中毒性肠麻痹缓解率分别为 5 7.7%、6 9.2 %和 76 .9% ,与对照组比较有显著差异 ;治疗后 72小时胃肠营养耐受率达 5 7.7% ,对全身炎症反应综合征 (SIRS)的治疗有效率为 6 5 .4% ,与对照组比较均有显著差异 (P均 <0 .0 5 ) ;大黄治疗后各时间点血浆内 TNFα浓度均显著低于对照组 (P均 <0 .0 0 1) ,治疗后 72小时其基因表达亦显著低于对照组(P<0 .0 5 )。灌肠组 :大黄治疗后 72小时 6 1.1%的患者恢复胃肠蠕动 ,与对照组比较有显著差异 (P<0 .0 5 ) ;胃肠营养耐受率及对 SIRS的治疗有效率与对照组比较无显著差异 ;大黄治疗后 2 4、48和 72小时 ,血浆内TNFα浓度均显著低于对照组 (P均 <0 .0 0 1) ,治疗后 72小时其基因表达亦显著受抑 (P<0 .0 5 )。大黄治疗后各时间点鼻饲组血浆内 TNFα浓度显著低于灌肠组 (P<0 .0 0 5 ) ,且鼻饲组抑制 TNFα基因表达的程度显著高于灌肠组 (P<0 .0 5 )。结论 :大黄鼻饲给药和保留灌肠能有效?

Objective:To study the mechanism of rhubarb against systemic inflammation response in critical illness,and investigate the effect of rhubarb by different ways of administration,including nasal feeding and retention enema.Methods:Septic patients with toxic paralytic ileus in ICU were enrolled in this study.Gut peristalsis,concentration of serum tumor necrosis factorα(TNFα) and expression of TNFα gene in blood cells were observed after rhubarb administration.Results:In the nasal feeding group,57 7%,69 2% and 76 9% of patients were recovered from toxic paralytic ileus 24,48 and 72 hours after rhubarb intake.57 7% patients could tolerate enteric nutrition and systemic inflammatory response syndrome (SIRS)was alleviated in 65 4% patients 72 hours later.There was a significant difference between the treatment group and control group ( P <0 05).The concentration of serum TNFα was also much lower in treatment group than that in controls at various time points (all P <0 001).In the retention enema group,the toxic paralytic ileus was alleviated in 61 1% patients ( P <0 05 vs.controls).Enteric nutrition was achieved and SIRS was improved in 44 4% patients 72 hours after rhubarb treatment.In addition,rhubarb decreased the concentration of serum TNFα in nasal feeding group more effectively than that in the retention enema group( P <0 05).Moreover,rhubarb could obviously inhibit the expression of TNFα gene in blood cells in the nasal feeding group and retention enema group ( P <0 05).However,the nasal feeding of rhubarb was more defective on TNFα gene expression than rhubarb retention enema.Conclusions:The nasal feeding and retention enema of rhubarb can effectively relieve toxic paralytic ileus and inhibit the expression of TNFα gene in critical illness.Nevertheless,the effectiveness of rhubarb by nasal feeding seems to be better than that by retention enema.