硝黄汤鼻饲联合灌肠对重症慢性阻塞性肺疾病患者肠屏障功能障碍的影响

摘要

目的 观察硝黄汤鼻饲联合灌肠对重症慢性阻塞性肺疾病(COPD)患者肠屏障功能障碍的影响.方法 将80例COPD肠屏障功能障碍患者随机分为2组.对照组40例予常规治疗,治疗组40例在第1 d留取试验标本后即在常规治疗的同时予硝黄汤鼻饲联合灌肠.2组分别于治疗前及治疗第1、3、5 d观察患者肠鸣音、急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分,检测血浆二胺氧化酶(DAO)、肠脂肪酸结合蛋白(IFABP)及内毒素水平,记录患者ICU住院天数,观察2组治疗前后丙氨酸氨基转移酶(ALT)、血肌酐(Cr)及尿素氮(BUN)情况.结果 对照组治疗后第1、3、5 d肠鸣音改变、APACHEⅡ评分、DAO、IFABP及内毒素水平与本组治疗前比较差异均无统计学意义(P>0.05).治疗组治疗后第1 d肠鸣音与本组治疗前有统计学意义(P<0.05),APACHEⅡ评分、DAO、IFABP及内毒素水平与本组治疗前比较差异均无统计学意义(P>0.05);第3、5 d肠鸣音、APACHEⅡ评分、DAO、IFABP及内毒素水平与本组治疗前比较差异均有统计学意义(P<0.05).治疗后第1 d治疗组肠鸣音改变与对照组同期比较差异有统计学意义(P<0.05),APACHEⅡ评分、DAO、IFABP及内毒素水平改变与对照组同期比较差异无统计学意义(P>0.05);治疗后第3、5 d治疗组肠鸣音改变、APACHEⅡ评分、DAO、IFABP及内毒素水平改变与对照组同期比较差异均有统计学意义(P<0.05).2组治疗前后ALT、Cr及BUN组内及组间比较差异均无统计学意义(P>0.05).结论 硝黄汤鼻饲联合灌肠能改善重症COPD患者肠屏障功能障碍,对肝肾功能无影响.%Objective To observe the effects of nasal feeding and enema of Xiaohuang decoction on intestinal barrier dysfunction in critical chronic obstructive pulmonary disease (COPD) patients.Methods 80 patients with intestinal barrier dysfunction were randomly divided into two groups.40 cases in control group were treated by routine treatment, and 40 cases in treatment group were treated by nasal feeding and enema of Xiaohuang decoction on the basis of control group treatment after samples collected at the first day.The gurgling sound, acute physiology and chronic health evaluationⅡ(APACHEⅡ) were measured at before and 1, 3, 5 d after treatment in two groups.The plasma diamine oxidase (DAO),intestinal fatty acid binding protein (IFABP), endotoxin were observed, and the hospital stay was recorded.The alanine aminotransferase (ALT), creatinine (Cr) and urea nitrogen(BUN) before and after treatment were observed in two groups.Results There were no statistical differences on gurgling sound, APACHEⅡ, DAO, IFABP and endotoxin before and after treatment in control groups (P>0.05).There was statistical differences on gurgling sound 1 d after treatment in treatment grpup (P<0.05),with no statistical differrnces on APACHEⅡ,DAO,IFABP andendotoxin (P>0.05).There were statistical differenceson gurgling sound,APACHEⅡ, DAO, IFABP and endotoxin before and 3、5 d aftertreatment in treatment group.There was statistical difference on gurgling sound after 1 d treatment.ascompared with those in contral group at the same periocl(P<0.05),with no statistical differences on APACHEⅡ, DAO, IFABP and endotoxin (P>0.05).There were statistical differences on gurgling sound,APACHEⅡ, DAO, IFABP and endotoxin after 3、5 d treatment in treatment group as compared with those in contral group at the same periocl (P<0.05).There were no statistical differences on ALT, Cr and BUN between before and after treatment in two groups, as well as the comparison between two group (P>0.05).Conclusion Nasal feeding and enema of Xiaohuang decoction can improve intestinal barrier dysfunction in critical COPD patients, with no adverse reaction of hepatorenal function.