卡巴胆碱对创伤患者肠屏障功能的保护作用  

The protection of carbachol on intestinal barrier function in patients with trauma

作　　者：王印华[1] 尤丕聪[2] 唐明贵[1] 王宝华[1] 柴海霞[1] 浦践一[1] 

机构地区：[1]河北联合大学附属医院重症医学科,河北唐山063000 [2]天津医院重症医学科,天津300210

出　　处：《中国中西医结合急救杂志》2014年第4期254-257,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省科技计划项目（12276104D-6）

摘　　要：目的：观察卡巴胆碱对创伤患者肠屏障功能的保护作用。方法采用前瞻性随机对照临床研究方法，选择河北联合大学附属医院重症医学科收治的急诊创伤后合并多器官功能障碍综合征（MODS）患者70例。按随机数字表法分为卡巴胆碱组（37例）和莫沙必利组（33例），两组均给予抗菌药物、器官功能支持及外科手术等对症治疗；卡巴胆碱组同时每次经胃管注入卡巴胆碱0.2 mg/kg，每日2次，若用药3 d仍无排气排便，药量加倍；莫沙必利组则给予莫沙必利每次5 mg，每日3次；两组疗程均为7 d。于入院后1、3、5、7 d清晨采集空腹外周静脉血，检测二胺氧化酶（DAO）活性、中性粒细胞（PMN）CD11b^＋、CD18^＋表达率、肿瘤坏死因子-α（TNF-α）及白细胞介素-10（IL-10）的含量，并观察临床疗效。结果与莫沙必利组比较，卡巴胆碱组治疗7 d后临床总有效率明显升高〔70.3%（26/37）比45.5%（15/33），P＜0.05〕。卡巴胆碱组血DAO活性、PMN的CD11b^＋及CD18^＋表达率、TNF-α、IL-10水平随时间延长呈下降趋势，治疗7 d时达谷值，与莫沙必利组同期比较差异有统计学意义〔DAO（mg/L）：3.21±0.52比3.93±0.51，CD11b^＋：（14.89±2.16）%比（28.92±1.59）%，CD18^＋：（53.67±2.44）%比（72.46±4.08）%，TNF-α（ng/L）：111.44±16.42比129.73±18.74，IL-10（ng/L）：67.71±38.83比121.54±40.23，均P＜0.05〕，莫沙必利组各时间点变化不明显。结论卡巴胆碱可降低创伤后肠屏障功能障碍患者肠道缺血/再灌注（I/R）损伤，减少炎症介质释放，促进肠蠕动，在保护肠屏障功能方面有临床价值。Objective To observe the protection of carbachol on intestinal barrier function in patients with trauma. Methods A prospective randomized controlled trial was conducted. Seventy patients after trauma with a definite diagnosis of multiple organ dysfunction syndrome（MODS）from Department of Critical Care Medicine in Hebei United University Affiliated Hospital were included. According to random number table,the patients were divided into a carbachol treatment group（37 cases）and a mosapride citrate treatment group（33 cases）,and all the patients in the two groups were treated by antibacterial drugs,supportive agents for organ function,surgery, etc symptomatic treatment. Based on the conventional treatment,in the carbachol treatment group,carbachol was administered through a stomach tube at the dose of 0.2 mg/kg,twice a day,and the dose was doubled if no exhaust or defecation persisted for 3 days after treatment,while in the mosapride group,mosapride citrate was given at the dose of 5 mg once and thrice a day,the therapeutic course of both groups being 7 days. On the 1st,3rd,5th, 7th day after admission,peripheral venous fasting blood in early morning was collected,the activity of diamine oxidase（DAO）,expression rates of CD11b^＋and CD18^＋in polymorphonuclear neutrophil（PMN）,contents of tumour necrosis factor-α（TNF-α）and interleukin-10（IL-10） were detected,and the clinical curative effects were observed. Results Compared to the mosapride citrate treatment group,the total effective rate was significantly higher in the carbachol treatment group on the 7th day after treatment〔70.3%（26/37）vs. 45.5%（15/33）,P〈0.05〕. The activity of DAO,expression rates of CD11b＋and CD18＋in PMN,contents of TNF-αand IL-10 in the carbachol treatment group were decreased with the extension of time,and reached valley values on the 7th day,the differences were statistically significant in the comparisons with those in mosapride citrate treatment group at the same time point〔DAO（mg/L）：3.21�

关 键 词：卡巴胆碱 创伤 肠屏障功能障碍 多器官功能障碍综合征 

分 类 号：R574[医药卫生—消化系统]