摘要：
Objective To observe the changes of intestinal barrier function in patients with acute severe organophosphorus pesticide poisoning (ASOPP)and the effect of early enteral nutrition on them.Methods A single-center,single-sample,prospective,randomized controlled clinical trial was conducted.A total of 50 patients with ASOPP were divided into 24 h enteral nutrition group (group A) and 48 h (48-72 h) enteral nutrition group (B group) according to the order of hospitalization.The two groups received equal calorie nutritional support,and Serum D-lactic acid (D-LA) and serum human diamine oxidase (DAO)were detected immediately after admission and at 48 h,72 h and 144 h.At the same time,the worst value of APACHE-Ⅱ score was recorded,and the correlation between DAO,D-LA and APACHE-Ⅱ score was analyzed.The serum concentration of D-LA and DAO in 15 healthy adults were detected as healthy control group.Results There was no statistical difference in gender,age,poisoning time and organophosphorus pesticide components between group A and B (P＞0.05).The distribution of D-LA concentration in group A poisoned patients at admission,48 h,72 h and 144 h was (66±19) μg/L,(68±21) μg/L,(66±19) μg/L,(63±17)μg/L,while in group B they were(62± 15) μg/L,(58±17) μg/L,(58±16) μg/L,(67±9) μg/L.There was no statistical difference between the two groups in D-LA concentration and that of healthy people [(67±17) μg/L,P＞0.05].The distribution of DAO concentration in group A poisoned patients at admission,48 h,72 h and 144 h was (2.1±0.6) μg/ml,(2.1 ±0.5) μg/ml,(2.2±0.4) μg/ml,(2.2±0.5) μg/ml,while in group B they were (2.1±0.5) μg/ml,(2.1±0.5) μg/ml,(2.2±0.5) μg/ml,(2.1 ±0.4) μg/ml.DAO concentration in the early stage of the intoxication of the two groups were higher than that of healthy people (0.1 ±0.0 μg/ml) (P＜0.05).There is no statistical difference in DAO concentration between group A and B at different time points (P＞0.05).The APACHEE-Ⅱ score of 48 hours and 72 hours in group A (12.2 + 1.7,5.5 +2.1) was significantly lower than that in group B (14.1 +2.4,8.2 +2.6) (P＜0.05).D-LA,DAO concentration at different time points was not correlated with APACHE-Ⅱ score (P＞0.05).D-LA (r,P) was immediate admission (-0.17,0.24),48 h (0.04,0.79),72 h (0.32,0.06),144 h (0.29,0.07),and DAO (r,P) was immediate admission (-0.12,0.43),48 h (0.02,0.92),72 h (0.03,0.85),144 h (0.03,0.82).Conclusions Patients with ASOPP may have obvious injury at intestinal mucosa at early stage (144 h),but the intestinal permeability is normal.Early enteral nutrition therapy can promote the recovery of patients,but has low correlation with intestinal barrier function improvement.%目的 观察急性重度有机磷中毒患者肠黏膜屏障功能的改变及早期肠内营养对其影响.方法 采用前瞻性临床随机对照研究,纳入毫州市人民院收治的急性重度有机磷中毒患者50例,按照随机数表法分为24 h内开通肠内营养组(A组)和48 h(48～ 72 h)开通肠内肠内营养组(B组),两组患者接受等氮等热卡的营养支持,入院后即刻及第48 h、72 h、144 h检测患者血清D-乳酸(D-LA)、血清人二胺氧化酶(DAO),记录急性生理与慢性健康评分(APACHE-Ⅱ)的最差值,分析D-LA、DAO浓度分别与APACHE-Ⅱ评分的相关性.健康成人15例作为健康对照组,检测D-LA、DAO.结果 A、B组患者的性别、年龄、中毒时间、毒物种类差异均无统计学意义(均P＞0.05),具有可比性;A组中毒患者入院即刻、48 h,72 h、144 h的D-LA浓度分布为:(66±19) μg/L、(68±21) μg/L、(66±19) μg/L、(63±17) μg/L,B组中毒患者入院即刻、48 h、72 h、144h的D-LA浓度分布为:(62±15)μg/L、(58±17) μg/L、(58±16) μg/L、(67±9) ug/L,分别与健康人D-LA浓度(67±17) μg/L相比,差异均无统计学意义(均P＞0.05);A组中毒患者入院即刻、48 h、72 h、144h的DAO浓度分布为(2.1±0.6)μg/ml、(2.1±0.5) μg/ml、(2.2±0.4)μg/ml、(2.2±0.5) μg/ml;B组分别为:(2.1±0.5) μg/ml、(2.1±0.5)iμg/ml、(2.2±0.5)μg/ml、(2.1±0.4) μg/ml;分别与健康对照组DAO浓度(0.1±0.0)μg/ml相比,均高于健康对照组(均P＜0.05).A与B各时间点DAO浓度组间相比差异均无统计学意义(均P＞0.05).48 h、72 h的APACHE-Ⅱ评分,A组(12.2±1.7,5.5±2.1)均较B组(14.1±2.4,8.2±2.6)低(均P＜0.05).不同时间点的D-LA浓度与APACHE-Ⅱ评分均不相关,差异均无统计学意义(均P＞0.05),其(r,P)为入院即刻(-0.17,0.24)、48 h (0.04,0.79)、72 h (0.32,0.06)、144 h (0.29,0.07);不同时间点的DAO浓度与APACHE-Ⅱ评分均不相关,差异均无统计学意义(均P＞0.05),其(r,P)为入院即刻(0.12,0.43)、48 h(0.02,0.92)、72 h (0.03,0.85)、144 h (0.03,0.82).结论 急性重度有机磷中毒患者早期(144h内)肠黏膜存在明显损伤但通透性正常,早期开通肠内营养能改善患者病情,但与肠黏膜屏障的改善相关性较低.
