卡巴胆碱对急诊创伤后肠屏障功能障碍者心肌损伤的影响  

Influence of carbachol on myocardium in patients with intestinal barrier dysfunction induced by emergency trauma

作　　者：王印华[1] 王宝华[1] 唐明贵[1] 柴海霞[1] 浦践一[1] 

机构地区：[1]河北联合大学附属医院ICU,河北省唐山市063000

出　　处：《中国医药》2014年第4期464-467,共4页China Medicine

基　　金：河北省科技计划（12276104D-6）

摘　　要：目的 探讨卡巴胆碱对急诊创伤后肠屏障功能障碍患者心肌的保护作用.方法 选择70例急诊创伤后肠屏障功能障碍综合征的患者完全随机分为卡巴胆碱组（37例）和莫沙必利组（33例）,监测患者第1、7天外周血二胺氧化酶活性、嗜中性多形核粒细胞CD11b＋/CD18的表达率、左心室射血分数及肌酸激酶同工酶峰值,观察临床疗效.结果 治疗后7d,卡巴胆碱组有效26例（70.3％）,死亡7例（18.9％）;莫沙必利组有效15例（45.5％）,死亡13例（39.4％）.卡巴胆碱组有效率优于莫沙必利组,差异有统计学意义（Х^2=4.43,P＜ 0.05）.卡巴胆碱组治疗第1天血二胺氧化酶、CD11b＋和CD18分别为（4.8±0.5）kU/L、（30.6±3.6）％、（75.8±3.6）％,第7天分别为（3.2±0.5） kU/L、（14.9±2.2）％、（53.7±2.4）％;莫沙必利组治疗第1天血二胺氧化酶、CD11b＋和CD18分别为（4.7±0.3）kU/L、（31.1±2.9）％、（74.6±2.7）％,第7天分别为（3.9±0.5）kU/L、（28.9±1.6）％、（72.5±4.1）％,治疗第7天卡巴胆碱组患者血二胺氧化酶水平、嗜中性多形核粒细胞CD11b及CD18阳性表达率均低于入组第1天及莫沙必利组,差异均有统计学意义（均P＜0.05）.2组患者入组时肌酸激酶同工酶差异无统计学意义,而卡巴胆碱组肌酸激酶同工酶峰值明显低于莫沙必利组[（60±19） U/L比（79±18） U/L],差异有统计学意义（P＜0.05）;2组患者入组时左心室射血分数差异无统计学意义,卡巴胆碱组左心室射血分数峰值高于莫沙必利组[（60±7）％比（55±7）％],差异有统计学意义（P＜0.05）.结论 卡巴胆碱通过降低急诊创伤后肠屏障功能障碍患者肠道缺血再灌注损伤、减少活性炎症介质释放、促进肠蠕动,从而减轻心肌损伤,保护远隔脏器-心脏的功能.Objective To explore protection of carbachol for myocardium in patients with intestinal barrier dysfunction induced by emergency trauma.Methods Seventy patients after trauma with a definite diagnosis of multiple organ dysfunction syndrome in intensive care unit were included,were randomly divided into the carbachol group （n =37） and mosapride citrate group（n =33）.Diamine oxidase activity,expressions of CD11b ＋ and CD18 on polymor phonuclear meutrophilc（PMN） in peripheral blood and left ventricular ejection fraction（LVEF） were detected on the 1st and 7th day,as well as the peak contents of creatine kinase-MB （CK-MB）.Clinical effects were observed.Results After treatment of 7 days,26 cases（70.3%） in carbachol group were effective in treatment,7 cases（18.9%）died,while 15 cases（45.5%） in mosapride citrate group were effective in treatment,13 cases（39.4%） died.Carbachol group showed a higher effective rate than the mosapride citrate group,thus the scores had statistical difference（Х^2 =4.43,P 〈 0.05）.On the 1 st day,diamine oxidase,CD11b ＋ and CD18 in carbachol group was（4.8 ± 0.5） kU/L,（30.6 ± 3.6） %,（75.8 ± 3.6） %,on 7th day was （3.2 ± 0.5） kU/L,（14.9 ± 2.2）%,（53.7 ± 2.4）%.On the 1 st day diamine oxidase,CD11b ＋ and CD18 in mosapride citrate group was（4.7 ±0.3）kU/L,（31.1 ±2.9）%,（74.6 ±2.7）%,on 7th day was（3.9 ±0.5） kU/L,（28.9 ± 1.6）%,（72.5 ± 4.1）%.After treatment of 7 days,diamine oxidase,CD11b ＋ and CD18 in carbachol group was lower than the inclusion spot and mosapride citrate group,thus the scores had statistical difference（P 〈0.05）.CK-MB had no statistical difference at the moment of entering between the two groups.But in carbachol group,the peak contents of CK-MB was lower than that of mosapride citrate group[（60 ± 19）U/L vs （79 ± 18）U/L],scores had statistical difference（P 〈 0.05）.Left ventricular ejection fraction had no statistical difference at the moment of entering the group

关 键 词：心肌损伤 卡巴胆碱 急诊创伤 肠屏障功能障碍 

分 类 号：R541[医药卫生—心血管疾病]