中西医结合改善高龄患者体外循环后肠功能障碍

摘要

目的 探讨中西医结合治疗高龄患者体外循环后肠功能障碍的效果.方法 选取高龄患者54例,随机分为对照组、谷氨酰胺( Gln)组和中西联合组,Gln组在术日CPB开始后和术后2天内分别静脉给予Gln 0.4g/kg.联合组在Gln的基础上根据中医分型,于术前及术后给与不同中药制剂.术前及术后即刻、1天和2天检测血浆内毒素、白细胞介素-6( IL-6)以及二胺氧化酶(DAO)含量,同时应用彩色多普勒仪,于患者肠系膜上动脉的起始2 cm内进行检测舒张期峰值流速(EDV)、搏动指数(PI).结果 与对照组比较,体外循环后Gln组血浆内毒素水平、IL-6和DAO水平均降低.体外循环后及术后1天联合组较Gln组内毒素、IL-6以及DAO水平均降低.彩色多普勒分析EDV及PI,与对照组相比,联合组及Gln组术后EDV明显升高,PI降低,术后即刻及术后1天差异有统计学意义(p＜0.05).结论 谷氨酰胺二肽对体外循环后的肠黏膜屏障有一定的保护作用,联合应用中医药制剂更有利于高龄患者体外循环后肠功能的恢复.%Objective To study the effects of improving elderly patients with bowel dysfunction after cardiopulmonary bypass.Methods Choose 54 elderly patients with CPB were randomly divided into tree groups:the control group and the Gln group and the Combination group,every group has 18 patients.Glutamine(Gln) at 0.4 g/kg was administrated to the patients in the Gln group and the combination group during the beginning at CPB and two days after the operation.Based on the Gln group,the patients of The Combination group were given the different oral Chinese medicine before and after operation,according to syndrome differentiation classification.Plasma endotoxin,IL-6 and DAO were measured before operation and at the endof operation and 24 h,48 h after operation.At the same time,we used German Siemens Company's X3000 Color Doppler machine to test every group of patients superior mesenteric artery.We tested before surgery,and one to two days after operation,from the starting point within 2cmof the superior mesenteric artery and the angle between the ultrasound beam flow was less than 60 °,the probe frequency was 3.5 MHz.The detection of hemodynamic indexes were EDV and PI.Results After the test,the plasma endotoxin and IL-6 levels and DAO levels of the Gln group were reduced than the Control group after cardiopulmonary bypass.The plasma endotoxin and IL-6 levels and DAO levels of the Combined gnup were decreased than the Gln group after cardiopulmonary bypass and one day after operation.Analyze superior mesenteric artery diastolic velocity (EDV)and pulsatility index (PI) by the Color Doppler.After operation,the EDV in the Gln group and the Combined grup were significantly higher than the control group,the Pl were lower than the control group.The parameters levels have significant difference after cardiopulmonary bypass and one day after operation(P ＜ 0.05 ).The Combined group was improved than the Gln group after cardiopulmonary bypass and one day after operation.According to the traditional Chinese medicine diagnosis,there were eighteen patients in the Combined group,including fifteen patients in type of deficiency of both qi and yin and three patients in type of fu-viscera syndnome.All of the patients have defecated within tree days after operation.In the type of deficiency of both qi and yin nine patients were cured and six were shown to be effective after operation.All the patients in type of fuviscera syndrome were cured.Conclusion N(2)-L-Alanyle-L-Glutmaine have protective effect on the intestinal mucosal barrier after CPB.Combined traditional Chinese Medicine preparation was more conducive to the intestinal function recovery of elderly patients after cartiopulmonary bypass.