大黄素鼻饲对脓毒症急性胃肠功能损伤患者胃肠动力的改善作用

Effect of nasal feeding of rhubarb on gastrointestinal motility in sepsis patients with acute gastrointestinal injury

目的探讨鼻饲大黄素对脓毒症急性胃肠功能损伤患者胃肠动力的改善作用。方法60例脓毒症急性胃肠功能损伤患者随机分为大黄素治疗组和常规治疗组,两组均给予病因治疗、抗生素、营养支持等常规治疗;大黄素治疗组鼻饲大黄素(大黄制剂,溶于温开水50 m L中,浸泡至深褐色过滤取滤液,约38~40℃缓慢泵入胃管中,50 m L/h),10 g/次,3次/d,连续3 d;常规治疗组给予等量温开水。比较两组超声监测指标(胃窦收缩频率、胃排空速率、胃窦收缩幅度、动力指数)及临床观察指标(胃潴留量、反流/误吸、腹胀、腹泻、喂养中断)。结果与常规治疗组比较,大黄素治疗组胃窦收缩频率、胃排空速率、胃窦收缩幅度、动力指数增加(P均<0.001);胃潴留量、反流/误吸、腹胀、喂养中断的发生率降低(P均<0.05),但腹泻的发生未增加(P=0.389)。结论大黄素可促进脓毒症胃肠功能损伤患者胃肠动力的恢复,减少肠内营养喂养中断的发生且无明显胃肠不耐受表现。

Objective To investigate the effect of nasal feeding of rhubarb on gastrointestinal motility in sepsis patients with acute gastrointestinal injury(AGI).Methods Sixty sepsis patients with AGI were randomly divided into the rhubarb treatment group and routine treatment group,with 30 cases in each group.Both groups were given routine treatment such as etiological treatment,antibiotics and nutritional support.Patients in the rhubarb treatment group were given rhubarb preparation by nasal feeding[rhubarb preparation was dissolved in 50 m L warm water(38-40℃),soaked until dark brown,and then was slowly pumped into gastric tube(50 ml/h)],10 g/time,3 times/day,for 3 days,while patients in the routine treatment group were given the same amount of warm water.The ultrasound monitoring indicators(antral contraction frequency,gastric emptying rate,antral contraction amplitude,motility index)and clinical observation indicators(gastric residual volume,reflux/aspiration,abdominal distention,diarrhea and feeding interruption)were compared between the two groups.Result Compared with the routine treatment group,rhubarb treatment could increase the antral contraction frequency,gastric emptying rate,antral contraction amplitude and motility index in sepsis patients(all P<0.001),reduce the occurrence of gastric residual volume,reflux/aspiration,abdominal distention and feeding interruption in sepsis patients(all P<0.05),but did not increase the occurrence of diarrhea(P=0.389).Conclusion Rhubarb can promote the recovery of gastrointestinal motility in sepsis patients with AGI,and reduce the incidence of feeding interruption without gastrointestinal intolerance.