奥曲肽对粘连性肠梗阻患者肠黏膜屏障功能影响及疗效观察

Influence and Curative Effect of Octreotide on Intestinal Mucosal Barrier Function in Patients with Adhesive Ileus

目的:探讨奥曲肽对粘连性肠梗阻患者肠黏膜屏障功能的影响及疗效观察。方法:将80例粘连性肠梗阻患者随机分为奥曲肽组(n=40)和对照组(n=40)。对照组患者予以禁食、胃肠减压、全胃肠外营养和抗炎解痉止痛等基础治疗。奥曲肽组在此基础上加用奥曲肽0.1 mg皮下注射,q8h,至肛门排便排气。观察并比较两组患者治疗前和治疗5 d后肠黏膜屏障功能的变化,并进行临床疗效及药物不良反应观察。结果:治疗5 d后,两组患者血清内毒素和D-乳酸均明显下降(P<0.05或0.01),且奥曲肽组下降幅度明显大于对照组(P<0.05);奥曲肽组的临床总有效率为92.5%,明显高于对照组的75.0%(P<0.05)。两组患者治疗期间均未见明显的药物不良反应。结论:奥曲肽治疗腹部手术后粘连性肠梗阻具有较好的疗效及安全性,能明显改善其临床症状,作用可能与其能降低血清内毒素和D-乳酸水平、保护和改善患者的肠黏膜屏障功能相关。

Objective：To discuss the influence and curative effect of octreotide on the intestinal mucosal barrier function in the patients with adhesive ileus.Methods：Totally 80 cases of patients with adhesive ileus were selected and divided into octreotide group （n =40 cases） and the control group （n =40 cases） randomly.The patients in the two groups were given basic medical treatment such as fasting,gastrointestinal decompression,total parenteral alimentation （TPA）,anti-inflammation,spasmolysis and etc.The patients in octreotide group were additionally given 0.1 mg octreotide by hypodermic injection,once every 8h until defecation and gas passage.The changes of intestinal mucosal barrier function in the two groups before and 5d after the medical treatment were observed and compared,and the clinical curative effect and adverse drug reactions （ADR） were observed as well.Results：After the 5-day medical treatment,the serum endotoxin and D-lactic acid in the two groups were obviously declined （P ＜ 0.05 or P ＜ 0.01）,and the declining rate in octreotide group was much higher than that in the control group （P ＜ 0.05）.Meanwhile,the total clinical efficiency in octreotide group was 92.5％,which was much higher than that in the control group （75.0％,P ＜0.05）.There was no obvious ADR in the two groups.Conclusion：Octreotide has favorable curative effect without obvious ADR on adhesive ileus after abdominal operation,and can obviously improve the clinical symptom.The action mechanism has close relationship with the decrease of serum endotoxin and D-lactic acid levels to protect and improve the intestinal mucosal barrier function.