芒硝外敷联合生长抑素对不完全性粘连性肠梗阻患者炎症性肠黏膜损伤的保护作用

Protective effect of mirabilite combined with somatostatin on inflammatory intestinal mucosal injury in patients with incomplete adhesive intestinal obstruction

目的探讨芒硝外敷联合生长抑素对不完全性粘连性肠梗阻(adhesive intestinal obstruction,AIO)患者炎症性肠黏膜损伤的保护作用。方法选取2017年1月至2021年4月浙江省台州医院急诊科收治的腹部手术后不完全性AIO患者78例,采用随机数字表法分为对照组和联合组,每组各39例。两组患者均予禁食、持续胃肠减压、预防感染、营养支持及维持电解质及酸碱平衡等基础治疗。对照组予生长抑素针0.1mg皮下注射,8h/次。联合组在对照组基础上予芒硝外敷治疗,两组均连续治疗5d。比较两组治疗后肠功能恢复情况、治疗前后血清炎症因子[超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin,IL-6)和肿瘤坏死因子(tumor necrosis factor-α,TNF-α)]和肠黏膜损伤指标[血清内毒素(serum endotoxin,ET)、肠脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)和降钙素原(procalcitonin,PCT)]的变化情况,并评估临床疗效。结果联合组患者腹痛腹胀症状缓解时间、自主排气排便时间及胃管拔除时间短于对照组,差异有统计学意义(P<0.05);治疗5d后,两组患者血清hs-CRP、IL-6、TNF-α、ET、IFABP和PCT水平较治疗前明显下降,且联合组患者下降幅度更明显,差异均有统计学意义(P<0.05);同时联合组患者临床总有效率(94.87%)明显优于对照组(79.49%),差异有统计学意义(P<0.05)。结论芒硝外敷联合生长抑素治疗腹部手术后不完全性AIO患者的效果显著,能及早改善临床症状,作用机制可能与其能降低血清炎症因子和肠黏膜损伤指标水平,从而减轻炎症性肠黏膜损伤,保护胃肠功能有关。

Objective To investigate the protective effect of mirabilite combined with somatostatin on inflammatory intestinal mucosal injury in patients with incomplete adhesive intestinal obstruction(AIO).Methods A total of 78 patients with incomplete AIO after abdominal surgery who were treated in Taizhou Hospital of Zheiiang Province from January 2017 to April 2021 were selected and randomly divided into the control group and the combination group with 39 cases in each group.Both groups were given basic treatments such as fasting,continuous gastrointestinal decompression,infection prevention,nutritional support,and maintenance of electrolyte and acid-base balance.The patients in control group were subcutaneously injected with somatostatin needle 0.1mg,q8h.On the basis of the control group,patients in combination group were given external application of mirabilite for 5 days.The changes of intestinal function recovery between the two groups after treatment,serum inflammatory factors[hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]and intestinal mucosal injury indicators[serum endotoxin(ET),intestinal fatty acid binding protein(IFABP)and procalcitonin(PCT)]levels before and after treatment were observed and compared.Their clinical efficacy was assessed.Results The relief time of abdominal pain and bloating symptoms,the time of spontaneous exhausting and defecation and the time of gastric tube removal in combined group were shorter than those in control group,and the differences were statistically significant(P<0.05).The levels of hs-CRP,IL-6,TNF-α,ET,IFABP and PCT in two groups were significantly lower than those before treatment,and the decrease rate was more obvious in combination group(P<0.05);at the same time,the total clinical effective rate(94.87%)in combination group was better than that in control group group(79.49%),the difference was statistically significant(P<0.05).Conclusions The external application of mirabilite combined with somatostatin has significant effect in the treatment of patients with incomplete AIO after abdominal surgery,which can improve clinical symptoms as soon as possible.The mechanism of action may be related to its ability to reduce the levels of inflammatory factors and intestinal mucosal injury indicators,and reduce inflammatory intestinal mucosal damage and protect gastrointestinal function.