大黄对危重病患者胃肠道并发症的治疗研究  

Studies of Rhubarb against gastrointestinal complications in critically ill patients

作　　者：陈德昌[1] 杨兴易[1] 李红江[1] 景炳文[1] 

机构地区：[1]第二军医大学附属长征医院急诊科,上海20003

出　　处：《中华急诊医学杂志》2001年第3期164-167,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金资助项目 (395 70 6 88)

摘　　要：目的　研究大黄对危重病患者胃肠道并发症的治疗作用。方法　采用SWAN—GANZ导管监测血流动力学和全身氧输送和氧消耗。应用胃肠粘膜内pH值检测胃肠粘膜的血液灌流和氧合情况。观察大黄对危重病患者应激性胃肠粘膜病变及中毒性肠麻痹的疗效。结果 :大黄对危重症患者应激性胃肠粘膜病变伴出血的止血有效率达 73 % ,与洛赛克对照治疗组无差异 ;大黄对中毒性肠麻痹的有效率达 6 5 % ,明显高于西沙必利对照治疗组 (P <0 0 5 ) ;危重症患者心排血指数、全身氧输送和氧消耗明显高于生理范围 ,但胃肠道仍处于严重缺血、低氧状态 ;大黄对血流动力学和全身氧输送和氧消耗无明显影响 ,但大黄能显著提高胃肠粘膜内pHi(P<0 0 0 1) ,说明大黄能明显改善胃肠道氧合和功能状况。结论　大黄能改善危重症患者胃肠粘膜的血液灌流和氧合状况 。Objective:To study the effect and mechanism of rhubarb on gastrointestinal complications in critically ill patients.Methods:79 septic patients,who suffered from stress ulcer and or toxic ileus,were divided into two groups:rhubarb treatment group and control group.64 patients in therapeutic group were treated with rhubarb at a dose of 25 mg/kg every 8hrs.15 patients in the control group were treated with losec or cisapride.SWAN GANZ catheters were used to monitor the hemodynamics and systemic oxygen metabolism.The gastrointestinal perfusion was evaluated by intramural pH(pHi).Results:47 out of 64 patients with stress ulcer stopped bleeding after rhubarb treatment.There was no significant difference between the therapeutic effect of rhubarb and losec on the stress ulcer.28 out of 43 patients with paralytic ileus improved after rhubarb treatment.The effect of rhubarb on paralytic ileus was better than that of western medicine,cisapride.There was significant difference between rhubarb treatment group and control group.Although the cardiac index,systemic oxygen delivery and oxygen consumption in those critically ill patients were above physiological range,the gastrointestinal mucosa was still hypoperfused.Rhubarb could obviously increase gastrointestinal pHi(P<0 001),which means that rhubarb could improve the gastrointestinal blood perfusion.However,rhubarb had no effect on cardiac index,oxygen delivery and oxygen consumption in those patients.Conclusion:Rhubarb has a good therapeutic effect on stress ulcer and paralytic ileus,and can improve the gastrointestinal blood perfusion in critically ill patients

关 键 词：大黄 脓毒症 危重病 中医药治疗 应激性胃肠粘膜病变 肠麻痹 血流动力学 

分 类 号：R605.97[医药卫生—急诊医学]