山莨菪碱在严重烧伤患者脓毒症防治中的作用

Anisodamine in prevention and treatment of sepsis of severely burned patients

目的 观察严重烧伤患者伤后早期使用山莨菪碱对脓毒症的预防及疗效。 方法 1998年 4月至 1999年 11月对伤后早期收治的大面积烧伤患者 42例 ,随机分为两组。治疗组 2 0例 ,常规复苏加山莨菪碱治疗。对照组 2 2例 ,除不用山莨菪碱治疗外 ,其它复苏方案同治疗组。观察脓毒症发病率。同时采用自动监测仪对胃肠道粘膜pH值 (pHi)进行连续观察。测定血浆二胺氧化酶(DAO)和内毒素水平的变化。分析伤后早期pHi与血浆DAO、内毒素水平的相关性。观察已发生脓毒症的患者 ,用大剂量山莨菪碱短程治疗时各指标的改变。 结果 使用山莨菪碱治疗组脓毒症发病率为 2 0 0 % (4 / 2 0 ) ,明显低于对照组 (4 0 9% ,9/ 2 2 ) (P <0 0 5 ) ,伤后早期各时间点pHi值均显著高于对照组 (P <0 0 5 ) ,且恢复较早 ,同时血浆DAO和内毒素水平显著低于对照组。伤后早期 ,pHi值与血浆DAO、内毒素水平呈显著负相关 (P <0 0 5 ,P <0 0 1)。脓毒症发生时 ,pHi再度降低及血浆DAO和内毒素水平再度升高。然而 ,大剂量山莨菪碱短程使用后 ,各项指标显著改善 (P <0 0 5 )。 结论 烧伤后早期肠粘膜缺血性损伤在脓毒症发生发展过程中起重要作用。山莨菪碱具有较好的防治脓毒症的效果。

Objective[WT5”BZ] To observe the preventive effect of anisodamine on possible sepsis of patients with major burns and the effect of anisodamine on patients with sepsis. [WT5”HZ]Methods[WT5”BZ] Forty two patients with extensive burn admitted to our burn institute from April 1998 to November 1999 were divided randomly into two groups: treatment group (T group) and control group (C group). In the T group, all 20 patients received fluid resuscitation regimen with anisodamine, and in the C group, 22 patients received the regimem with no anisodamine. A tonometery catheter was positioned in the stomach, connecting with the automatic gas analysis machine (Datex Engtrom Corporation, Dutch) for determining gastric intramucosal pH (pHi). The plasma concentrations of diamine oxidase (DAO) and endotoxin were measured.Correlation analysis between pHi, DAO and endotoxin were made respectively during early stage of postburn. All the parameters in 7 patients with sepsis before and after administration of anisodamine were compared with those in 6 patients with sepsis without use of anisodamine. [WT5”HZ]Results[WT5”BZ] The incidence of sepsis in the T group was lower (20 0%) than that in C group (40 9%). The gastric pHi value in the early period of postburn was significantly higher in the T group than in the C group ( P <0 05). Concurrently, the plasma concentrations of DAO and endotoxin were significantly lower in the T group than in the C group ( P <0 05 or 0 01). A significant negative correlation was seen between the gastric pHi and respective values of DAO, endotoxin ( P <0 05 or 0.01). There were a decrease in gastric pHi,and an increase in plasma DAO and endotoxin level in patients with septic episode; however all the parameters after administration of anisodamine were improved compared with those in septic patients without use of anisodamine.[WT5”HZ] Conclusions[WT5”BZ] Intestinal ischemic injury plays an important role in provoking sepsis during early postburn period. Anisodamine is effective in restoring intestinal circulation both in the shock phase and after the development of sepsis. [WT5”HZ]