梗阻性黄疸时内毒素血症对肾功能的影响及胆酸钠、乳果糖和山莨菪碱的干预效应

Effect of endotoxemia on renal function in patients with obstructive jaundice and intervention by sodium cholate, lactulose, and anisodamine

目的 观察梗阻性黄疸患者手术前后血中内毒素含量、肾功能变化及胆酸钠、乳果糖和山莨菪碱的干预效应。方法 将 4 8例梗阻性黄疸患者随机分为对照组 (n =15 ) ,胆酸钠治疗组(n =11) ,乳果糖治疗组 (n =10 ) ,山莨菪碱治疗组 (n =12 ) ;另选 2 1例胆囊结石患者为非梗阻性黄疸对照组。观察各组手术前后血中内毒素含量、肾功能变化及药物治疗后的变化。结果 梗阻性黄疸时血中内毒素水平明显升高 ,内生肌酐清除率明显下降 ,各治疗组血中内毒素水平下降 ,内生肌酐清除率上升。结论 梗阻性黄疸时肠源性内毒素是导致肾功能损害的重要原因。胆酸钠、乳果糖和山莨菪碱可降低血中内毒素水平 ,对肾功能有保护作用。

Objective To observe the change of perioperati ve endotoxin (ET) level and renal function in obstructive jaundice (OJ) patient and the effect of sodium cholate,lactulose, and anisodamine.Methods Forty-eight OJ patients were randomly divided in to control group(n=15), sodium cholate treatment group(n=11), lactul ose treatment group (n=10) and a anisodamine treatment group(n=12), 21 patients with cholecystolithiasis served as non-jaundiced control group. The levels of plasma ET and endogenous creatinine clearance rate (Ccr) were determi ned in all the cases.Results Compar ed with non-jaundiced control group, plasma ET level increased significantly an d Ccr significantly decreased in OJ group (P<0.01), Peripheral blood ET le vel,especially portal vein blood ET level decreased and Ccr increased in preoper ation period in each of sodium cholate or lactulose or anisodamine treatment gro up.Conclusions Gut-derived endotox emia is one of the important causes of renal injury in OJ. Sodium cholate, lactu lose and anisodamine effect a decrease of the endotoxin level, hence protect kid ney function in OJ patients.