腹腔镜下氧化苦参碱腹腔灌洗对重症急性胰腺炎肠粘膜屏障损伤的作用

Effects of laparoscopically abdominal lavage with oxymatrine on intestinal mucosal barrier injury in severe acute pancreatitis

目的:探讨腹腔镜下氧化苦参碱(oxymatrine,OM)腹腔灌洗对重症急性胰腺炎(severe acute pancreatitis,SAP)的治疗作用及效果。方法:随机将20例SAP患者分为对照组(n=10)与OM灌洗组(n=10);两组均于腹腔镜下腹腔置管灌洗。对照组术后每12 h使用500 ml生理盐水灌洗腹腔,OM灌洗组术后每12 h应用500 ml OM溶液(200 mg OM)灌洗腹腔,分别于术前1 d(T0)及术后第1天(T1)、第2天(T2)、第3天(T3)抽取静脉血,测定血浆D-乳酸、内毒素浓度。结果:T0时,两组患者血浆D-乳酸浓度、血浆内毒素浓度相比差异无统计学意义(P>0.05);T1、T2、T3时,OM灌洗组血浆D-乳酸浓度、血浆内毒素浓度显著下降(P<0.05)。结论:腹腔镜下OM腹腔灌洗治疗SAP可减少、稀释腹腔渗出的大量炎性介质,且对肠黏膜屏障的损伤及细菌移位具有治疗作用。

Objective：To evaluate the role of laparoscopically abdominal lavage with oxymatrine（OM） in the treatment of severe acute pancreatitis（SAP）.Methods：Twenty patients with SAP were randomly divided into OM lavage group（n=10） and control group（n=10）.The abdominal cavity of the two groups was lavaged by laparoscopy.After operation the abdominal cavity of control group was lavaged by 500 ml saline every 12 h,OM lavage group used 500 ml OM solution（200 mg OM） per 12 h.Plasma endotoxin and D-lactic acid levels were determined at the day before operation（T0） and 1,2,3 days after operation（T1,T2,T3）.Results：There were not significant differences in plasma level of D-lactic acid and endotoxin between the control group and OM lavage group at D0（P0.05）.Compared with the control group,plasma D-lactic acid and endotoxin levels of OM lavage group were significantly decreased at T1,T2,T3（P0.05）.Conclusions：Laparoscopically abdominal lavage with OM in the treatment of SAP can not only reduce and dilute the large number of inflammatory mediators in exudates at peritoneal cavity,but can also treat mucosal barrier dysfunction and prevent bacterial translocation.