生长抑素治疗急性粘连性肠梗阻的疗效及对肠黏膜屏障功能的保护作用

Curative effect of somatostatin on acute adhesive intestinal obstruction and its protection effect on intestinal mucous membrane barrier function

目的探讨生长抑素治疗急性粘连性肠梗阻的疗效及对肠黏膜屏障功能的保护作用。方法选取90例急性粘连性肠梗阻患者随机分为研究组和对照组各45例。对照组患者予以禁食禁水、持续胃肠减压、抗生素抗感染、解痉止痛、纠正水电解质失衡及全胃肠外营养等常规治疗。研究组加用生长抑素针3 mg＋生理盐水50 m L微泵,（4~6）m L/h,直至患者肛门排便排气或中转手术时停止治疗。对照组患者除不使用生长抑素针外其余治疗与研究组相同。观察并比较两组患者的治疗前和治疗5 d后血清内毒素、二胺氧化酶（DAO）、降钙素原（PCT）水平的变化,并评估比较其临床疗效及不良反应。结果治疗5 d后,两组患者血清内毒素、DAO和PCT水平较前均明显下降（P〈0.05或P〈0.01）,且研究组下降变化幅度较对照组更明显（P〈0.05）;同时在临床总有效率方面研究组（95.56%）明显高于对照组（80.00%）（χ2=5.07,P〈0.05）;对照组和研究组治疗期间分别出现不良反应3例（6.67%）和5例（11.11%）,两组比较差异无统计学意义（χ2=0.14,P〉0.05）。结论生长抑素用于治疗腹部手术后粘连性肠梗阻的疗效较确切,能明显改善其临床症状,且安全性较佳,其作用机制可能与其能降低血清内毒素、DAO和PCT水平,保护与修复肠黏膜屏障功能密切相关。

Objective To discuss curative effect of somatostatin on acute adhesive intestinal obstruction and its protec- tion effect on intestinal mucous membrane barrier function. Methods All 90 cases of patients with acute adhesive in- testinal obstruction were divided into two groups, with 45 cases of patients in research group and control group respec- tively. The patients in control group were given routine medical treatment, such like fasting, water-fast, continuous gas- trointestinal decompression, antibiotics to prevent infection, relieving spasm and pain, adjustment of water-electrolyte imbalance, total parenteral alimentation（TPA） and etc. The patients in research group were additionally given 3 mg so- matostatin injection, 50 mL normal saline（NS） with minipump by 4 to 6 mL per hour, until cacation or exhaust from anus, given transit operation treatment or termination of treatment, while the patients in control group were given the same medical treatment as that in research group except for somatostatin. The changes of serum endotoxin, diamineoxi- dase （DAO）and procalcitonin（PCT）levels of patients in two groups before and 5 days after medical treatment were ob- served and compared, and the clinical curative effect and untoward effect were evaluated as well. Results After 5 days＇ medical treatment, the serum endotoxin, DAO and PCT levels of patients in two groups were obviously declined than before （P〈0.05 or P〈0.01）, and the declining rate of patients in research group was much higher than that in control group（P〈0.05）, and meanwhile, the total clinical efficiency of patients in research group （95.56% ）was much higher than that in control group （80.00%）（X2=5.07, P〈O.05）. 3 cases（6.67%） and 5 cases（ll.ll%） of untoward effect were appeared on patients in control group and research group during treatment, and no statistical differences were appeared after comparison（x2=O. 14, P〉0.05）. Conclusion The somatostatin has reliable curative effect on adhesive intestinal ob- struction after abdominal operation, and can obviously improve clinical symptom with high security, whose mechanism of action may have close effect on reducing serum endotoxin, DAO and PCT levels and protecting and repairing in- testinal mucous membrane barrier function.