大黄联合山莨菪碱对重度创伤患者胃黏膜酸度的影响  

Influence of rhubarb (大黄) combined with scopolamine on gastric mucosal barrier in patients with severe trauma

作　　者：徐杰[1] 邓梦华[1] 张斌[1] 冯锦昉[1] 潘永[1] 张兴胜[1] 林旋[1] 

机构地区：[1]广东省佛山市中医院ICU,广东佛山528000

出　　处：《中国中西医结合急救杂志》2007年第5期278-280,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：广东省中医药管理局立项课题(粤中医〔2002〕74号)

摘　　要：目的:观察大黄联合山莨宕碱对重度创伤患者胃肠道黏膜屏障的保护作用。方法:选择40例重度创伤患者创伤严重度评分(ISS)≥25分,按随机原则分为治疗组和对照组,每组20例。治疗组在第一次测定胃肠黏膜pH值(pHi)后开始给予山莨菪碱(静脉)和生大黄粉(灌胃),其余治疗与对照组相同。观察入院时及入院后24、48和72h的循环指标平均动脉压(MAP)、心率(HR)、pHi、血乳酸、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)等指标的变化。结果:对照组和治疗组的MAP、HR和pHi均呈升高趋势,且72h治疗组MAP和pHi较对照组显著升高,差异有显著性(P均<0.05);动脉血乳酸值均降低,48h开始治疗组较对照组显著降低(P均<0.05);两组IL-6、TNF-α均升高,而治疗组升高程度较对照组小,72h时差异有显著性(P均<0.05)。结论:大黄联合山莨宕碱对重度创伤患者胃肠道黏膜屏障具有保护作用,其机制主要与改善局部微循环、降低乳酸、升高pHi以及抑制IL-6、TNF-α细胞因子的释放等作用有关。Objective.. To investigate the protective effect of rhubarb （大黄） combined with scopolamine on gastric and gut mucosal barrier in patients with severe trauma. Methods： Forty patients with severe trauma, injury severity score （ISS）≥ 25, were randomly divided into two groups （each n = 20）, namely common therapy group （CM group） and rhubarb （infused into stomach） combined with scopolamine group （RS group）. In RS group, rhubarb combined with scopolamine were given just after the first time measuring gastrointramucosal pH （pHi）, the other treatment was the same as CM group. The mean arterial pressure （MAP） and heart rate （HR） were recorded, and phi, lactic acid, interleukin - 6 （IL - 6） and tumor necrosis factor -α （TNF-α） were measured on admission and at 24, 48 and 72 hours after admission. Results：The MAP, HR and phi were uptrend in both groups. There were significant increase in MAP and phi of RS group at 72 hours compared with those of CM group （both P〈 0. 05）. The decline of artery lactic acid with significant differences were found between two groups from 48 hours （all P〈0.05）. The levels of IL - 6, TNF - α in CM group were significantly higher than those in RS group with significant difference at 72 hours （both P〈0.05）. Conclusion： Rhubarb combined with scopolamine can protect the gastric and gut mucosal barrier in patients with severe trauma; the protective effect may be related to the improvement of the local microcirculation, reduction of arterial lactic acid, increase of pHi and the inhibition of the release of inflammatory factors, such as IL -6 and TNF- α,etc.

关 键 词：大黄 山莨宕碱 重度创伤 胃肠道黏膜 

分 类 号：R26[医药卫生—中医外科学]