早期药物干预对脓毒症患者肠功能障碍的防治及预后影响  

Therapeutic and preventive effects of early drugs intervention on intestinal dysfunction in sepsis patients

作　　者：盛鹰[1] 谢晓洪[1] 金文静[1] 王静恩[1] 蔡金芳[1] 王志华[1] 高波[1] 朱念[1] 

机构地区：[1]复旦大学附属浦东医院重症医学科,上海201399

出　　处：《中国急救医学》2015年第4期304-308,共5页Chinese Journal of Critical Care Medicine

基　　金：上海市浦东新区科技发展基金创新资金（PKJ2012-Y19）

摘　　要：目的探讨早期药物干预对脓毒症患者肠功能障碍的防治及预后影响。方法将92例入住我院综合性ICU未出现肠功能障碍的脓毒症患者随机分成干预组和对照组，每组各46例。除接受基础治疗外，干预组患者入组第一天开始鼻饲或口服马来酸曲美布汀及培菲康，连用7d以上，对照组则以生理盐水为对照。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。在各时点评定两组肠功能评分，统计两组肠内营养耐受率、MODS发生率及28d病死率。结果①干预组有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。②治疗前两组患者DAO活性及D-乳酸浓度比较差异均无统计学意义（P〉0．05），治疗第7天干预组DAO活性及D-乳酸浓度均高于对照组（P〈0．05）。两组组内比较，治疗前DAO活性及D-乳酸浓度最高，随着时间的推移，指标均逐渐下降（P〈0．05）。③治疗第5、7天干预组肠功能评分均低于对照组（第5天P〈0．05，第7天P〈0．01）；干预组肠内营养耐受率均高于对照组（第5天P〉0．05，第7天P〈0．05）。④干预组治疗第7天SOFA评分低于对照组（P〈0．05）。干预组在ICU住院期间MODS发生率为11．9％，低于对照组（29．3％，P〈0．05）；干预组28d病死率为4．76％，也低于对照组（14．63％），但差异无统计学意义（P〉0．05）。结论马来酸曲美布汀联合培菲康早期干预治疗有助于减少脓毒症患者肠功能障碍的发生，有利于肠内营养的顺利实施，进而改善脓毒症患者预后。Objective To study the therapeutic and preventive effects of early drugs intervention on intestinal dysfunction in sepsis patients. Methods All of 92 sepsis cases which were not complicated with intestinal dysfunction were randomly divided into intervention group and control group. Two groups were treated with the same conventional therapy. The patients of intervention group were given trimebutine maleatein and bifico for above 7 days by oral or nasal feeding, and physiological saline for control group. The blood plasma levels of diamine oxidase （DAO） activity and D - lactate concentration were tested by enzyme linked immunosorbent assay （ELISA） before the treatment, and on 3^rd, 5^th, 7^th day after admission in both groups. We also analyzed the rate of enteral nutrition tolerance and MODS incidence, 28d - fatality rate, the score of intestinal function and APACHE Ⅱ. Results （1）Four cases of intervention group and five cases of control group were expelled, because of ineonformity the research standard. （2）The blood plasma level of DAO activity and D - lactate concentration were not significantly difference between the two groups before treatment （ P 〉 0.05 ）, but compared with control group, DAO activity and D - lactate concentration were significantly lower in intervention group on 7^th day. The blood plasma levels of DAO activity and D - lactate concentration were highest in both two groups before treatment. With the time passing by, levels of the two indicators were decreased significantly in both two groups too （P 〈 0.05）. （3）Compared with the control group, the scores of intestinal function were significantly lower in intervention group on 5^th, 7^th day （5^th day P 〈 0.05, 7^th day P 〈0.01 ）, and the rate of enteral nutrition tolerance was lower on 5^th, Th day too, but statistical differences appeared on 7^th day （P 〈0.05）. （4）Compared with the control group, the score of APACHE Ⅱ was significantly lower in intervention group （P 〈 0.05 ）, the inc

关 键 词：马来酸曲美布汀 培菲康 脓毒症 肠功能障碍 早期干预 重症监护室 

分 类 号：R722.12[医药卫生—儿科]