培菲康联合马来酸曲美布丁早期治疗对脓毒症患者肠黏膜屏障功能的影响

Effects of early bifico and trimebutine maleatein intervention treatment on intestinal barrier function in sepsis patients

目的探讨培菲康联合马来酸曲美布丁早期治疗对脓毒症患者肠黏膜屏障功能的影响。方法将92例入住综合性ICU未出现肠功能障碍的脓毒症患者随机分成治疗组和对照组,每组46例。治疗组有4例及对照组有5例因不符合病例研究标准,最终被剔除本研究。除接受基础治疗外,治疗组患者入组第1天开始,鼻饲或者口服培菲康及马来酸曲美布丁,连用7 d以上,对照组则给生理盐水。采用酶联免疫吸附法(ELISA法)测定治疗前及第3、5、7天血浆二胺氧化酶(DAO)活性及D-乳酸浓度。在治疗后第5、7天评定2组肠功能。结果治疗前2组患者DAO活性及D-乳酸浓度比较差异均无统计学意义(t=0.802 9、0.340 3,P>0.05),治疗第7天,治疗组DAO活性及D-乳酸浓度均低于对照组(t=7.560 8、5.502 3,P<0.05)。2组组内比较,治疗前DAO活性及D-乳酸浓度最高,随着时间的推移,2项指标均逐渐下降(P<0.01,P<0.05)。治疗后第5、7天,治疗组肠功能评分均低于对照组[(0.485±0.312)分vs.(0.634±0.363)分;(0.216±0.354)分vs.(0.425±0.367)分,P<0.05]。而组内比较,2组第7天肠功能评分均低于第5天(P<0.05)。结论培菲康联合马来酸曲美布丁早期治疗有助于保护脓毒症患者肠黏膜屏障功能。

Objective To investigate the effect of bifico combined with trimebutine maleatein in early treatment on intestinal mucosa of patients with sepsis barrier function.Methods Ninty-two cases with sepsis patients in comprehensive ICU without intestinal dysfunction were randomly divided into treatment group and control group,46 cases in each group.Treatment group has 4 cases and control group has 5 cases did not meet the standards,finally were ruled out.In addition to receive the basic therapy,the treatment groups from the first day,nasal or oral take Bifico and trimebutine maleatein,continued for more than 7 d,while the control group was given saline.Using enzyme-linked immunosorbent assay(ELISA) to measure diamine oxidase(DAO) activity and D-Lactate concentration before treatment and 3,5,7 days after treatment.At 5th,7th days after treatment,intestinal function was evaluated in the 2 groups.Results Before treatment,DAO activity and D-lactic acid concentration in the 2 groups did not show significant differences(t = 0.802 9,0.340 3,P > 0.05),at seventh days of treatment,the treatment group’s activity of DAO and D-lactic acid concentrations were higher than those in the control group(t =7.560 8,5.502 3,P <0.05).Compared within the 2 groups,before treatment,DAO activity and D-lactic acid was the highest,along with the time pass,these indexes decreased gradually(P <0.01,P <0.05).At 5th,7 days after treatment,the treatment group’s intestinal function scores were lower than the control group[(0.485 ±0.312) vs.(0.634 ±0.363);(0.216 ±0.354) vs.(0.425 ±0.367),P <0.05].Compared within groups,2 groups’ seventh day’s bowel function score was less than fifth days(P <0.05).Conclusion Bifico combined with trimebutine maleatein in the early intervention can helps protect sepsis patients’ intestinal mucosal barrier function.