胆酸钠、乳果糖、山茛菪碱对梗阻性黄疸内毒素血症的临床治疗观察

Therapeutic effects of sodium cholate, lactulose and anisodamine on endotoxemia in patients with obstructive jaundice

目的 观察术前 3种药物对梗阻性黄疸 (简称 :梗黄 )病人抗内毒素血症的治疗作用。方法 48例梗黄病人分 4组在术前分别给予一般治疗 (A组 ) ,口服胆酸钠 (B组 ) ,口服乳果糖 (C组 )和静脉滴注山茛菪碱 (D组 )处理 ,和 2 1例无黄疸病人进行手术前后内毒素 (ET)含量测定。结果 (1)入院时梗黄各组外周血ET水平差异无显著意义 (P >0 .0 5 ) ,但均显著高于无黄疸组 (P <0 .0 1) ;(2 )A组门静脉血ET水平明显高于外周血 (P <0 .0 5 ) ;A组手术后 5dET水平降低不明显 ,随后ET逐渐下降 ,d 15接近正常水平 ;(3)B ,C 2组用药后外周血ET水平明显下降 ,术后ET水平继续降低 ,B ,C2组门静脉血ET水平低于A组 (P <0 .0 5 ) ;(4 )D组用药后外周血和术中门静脉血ET水平明显低于A组 (P <0 .0 5 ) ,术后也保持低水平。结论 术前应用胆盐。

Objective To study the therapeutic effects of pre-operative therapy with sodium cholate, lactulose and anisodamine on endotoxemia in patients with obstructive jaundice (OJ). Methods Forty eight patients with OJ were randomized into 4 groups according to the preoperative management of general treatment (group A), oral administration of sodium cholate (group B), oral administration of lactulose (group C) and intravenous dropping of anisodamine (group D). Other 21 cases of chronic cholelithiasis without jaundice were employed to serve as the control group. The level of plasma endotoxin (ET) was determined in all the patients. Results There was no difference of plasma ET level in peripheral blood among the former 4 groups (P>0.05) while the level was significantly higher in the former 4 groups than in the control (P<0.01) on the 1st day of hospitalization. In group A, the plasma ET level was markedly higher in portal vein blood than in peripheral blood during operation (P<0 05). Meanwhile, the ET levels in portal vein and peripheral blood were significantly decreased in groups B, C and D as compared with group A (P<0.05). Conclusions The use of sodium cholate, lactulose and anisodamine might effectively decrease the perioperative level of plasma ET in the patients with OJ.