乌司他丁对梗阻性黄疸患者围术期肠黏膜屏障功能的影响

Effect of ulinastatin on intestinal mucosal barrier during the perioperative period in patients with obstructive jaundice

目的探讨乌司他丁对梗阻性黄疸患者围手术期血浆内毒素水平及肠黏膜屏障功能的影响。方法 63例梗阻性黄疸患者随机分为试验组34例,对照组29例。所有患者均通过手术解除胆道梗阻,胆道引流,术后常规治疗,试验组加用乌司他丁,10万U溶于5%葡萄糖注射液250 ml中,静脉滴注,每天2次,疗程为7 d。测定术前1d、术后3 d、术后7 d 2组患者血浆内毒素水平和二胺氧化酶(DAO)活性,以及术前1 d、术后7 d 2组尿液乳果糖与甘露醇(L/M)比值。结果 2组术前1 d,血浆内毒素水平、DAO活性和尿L/M比值比较差异无统计学意义(P>0.05),术后3 d、7 d,2组内毒素水平、DAO活性均较术前1 d降低(P<0.05),且试验组较对照组降低更明显(P<0.05)。术后7 d,2组患者尿L/M比值明显低于术前1 d(P<0.05),且试验组较对照组降低更明显(P<0.05)。试验组临床总有效率明显高于对照组(94.1%vs.75.8%,P<0.05)。结论乌司他丁能够降低梗阻性黄疸患者血浆内毒素水平,降低肠通透性,减轻肠屏障功能的损伤。

Objective To investigate the effects of ulinastatin on peri-operation period＇ s barrier function of plasma endotoxin level and intestinal mucosa in patients with obstructive jaundice. Methods Sixty-three cases of patients with obstructive jaundice were randomly divided into experimental group with 34 cases, and control group with 29 cases. All patients were treated with operation of biliary tract obstruction, biliary drainage, postoperative routine treatment, experimental group combined with ulinastatin, 100 000 U dissolved in 5% glucose injection 250 ml, intravenous drip, 2 times a day, treatment for 7 d. Detected the level of plasma endotoxin and diamine oxidase （DAO） activity at 1 d before operation, after 3 d, 7 d after operation both in the 2 groups, and urinary lactulose and mannitol （L/M） ratio at 1 d before operation, 7 d after operation both in the 2 groups. Results 2 groups at 1 d before the operation, no statistical significance difference of plasma endotoxin level, DAO activity and urinary L/M ratio were found （ P 〉 0.05）, 3 d,7 d after operation, 2 groups of endotoxin level, DAO activity were decreased compared with 1 d before operation （ P 〈 0.05 ）, and the experimental group decreased significantly than control group（ P 〈0.05）. 7 d after operation, 2 groups＇ urinary L/M ratio was significantly lower than the 1 d before operation （ P 〈 0.05 ）, and the experimental group decreased more obviously than control group （ P 〈 0.05）. The total clinical effective rate in experimental group was significantly higher than that of the control group （94.1% vs. 75.8%, P 〈 0.05）. Conclusion Ulinastatin can decrease the plasma endotoxin level in patients with obstructive jaundice, reduce intestinal permeability, and reduce the intestinal barrier function injury.