加味参苓白术散对腹部术后保护肠粘膜屏障功能的研究

发布时间：2019-01-20 08:10

【摘要】：目的：肠道作为消化吸收营养物质的重要场所,在免疫系统调节方面也具有至关重要的作用。关于创伤、休克或肿瘤的多项研究说明,肠道粘膜组织在应激条件下,会发生一系列的形态学和功能学的改变,造成其屏障功能受损,进而易引起肠源性感染。腹部术后的患者处于一种应激环境中,其肠道粘膜的屏障功能受到一定的损伤,是否可以有效保护患者的肠粘膜屏障功能,直接关系到患者术后的康复以及生活质量。目前关于如何保护腹部术后患者的肠粘膜屏障功能的临床研究和动物实验研究不在少数,但是研究中医药对于腹部术后患者肠粘膜屏障功能的研究仍很少。所以,本研究旨在通过手术前后监测有关肠粘膜屏障功能的相关生化指标的变化,来进行加味参苓白术散对腹部术后保护肠粘膜屏障功能的临床研究。方法：选择近2年在我院外科病房需实行腹部手术治疗的60例患者作为研究对象,经抽签简单随机分为对照组和治疗组各30例。对照组给予肠内营养用药“瑞素”合谷氨酰胺颗粒治疗,治疗组给予肠内营养用药“瑞素”合加味参苓白术散治疗。分别监测对照组和治疗组在药物治疗前后的肠道粘膜屏障功能相关指标的变化(肠粘膜通透性、PCR检测细菌易位指标转阴率、C-反应蛋白浓度),进行统计分析中医药是否具有保护肠粘膜屏障的作用。成果：与治疗前相比,对照组和治疗组患者在给予不同药物治疗后肠粘膜屏障功能都得到了一定的保护,但治疗组在保护肠粘膜屏障功能的方面明显优于对照组,具体肠粘膜屏障功能指标检测结果分析如下：1、治疗组在腹部术后肠黏膜通透性指标较对照组有明显改善,差异有显著性意义(P0.05)。2、与对照组比较,腹部术后治疗组细菌易位指标转阴率上升更明显,差异有显著性意义(P0.05)。3、对照组和治疗组患者腹部术后C-反应蛋白的浓度指标明显上升,且在术后24小时达到最高,随后逐渐下降；与对照组比较,术后治疗组C-反应蛋白浓度指标下降更明显,差异有非常显著性意义(P0.05)。结论：本研究结果表明,在肠内营养用药“瑞素”治疗的基础上给予腹部术后患者加味参苓白术散的中医药治疗,对于降低肠粘膜通透性指标(L/M、D-乳酸)、细菌易位指标转阴率(PCR)、C反应蛋白浓度的变化具有明显作用,其疗效明显优于对照组。因此,认为给予腹部术后患者加味参苓白术散治疗对于保护肠粘膜屏障功能具有明显疗效,且接受治疗的患者未发现不良反应,安全性高,可在临床广泛推广。
[Abstract]:Objective: as an important place for digestion and absorption of nutrients, intestinal tract also plays an important role in the regulation of immune system. Many studies on trauma, shock or tumor show that a series of morphological and functional changes occur in intestinal mucosal tissue under stress, which results in impaired barrier function and may lead to enterogenic infection. Patients after abdominal surgery are in a stress environment, the intestinal mucosal barrier function is damaged, whether can effectively protect the intestinal mucosal barrier function, directly related to postoperative rehabilitation and quality of life. At present, there are many clinical and animal studies on how to protect the intestinal mucosal barrier function of patients after abdominal surgery, but there are few researches on the intestinal mucosal barrier function of patients after abdominal surgery with traditional Chinese medicine. Therefore, the purpose of this study was to monitor the changes of biochemical indexes related to intestinal mucosal barrier function before and after operation, and to carry out the clinical study on the protection of intestinal mucosal barrier function after abdominal operation by modified Shenling Baizhu Powder. Methods: sixty patients who needed abdominal operation in surgical ward of our hospital in recent 2 years were selected as the research objects. The patients were divided into control group and treatment group by drawing lots. The control group was treated with enteral nutrition "Ruisin" combined with glutamine granules, and the treatment group was treated with enteral nutrition drug "Ruisu" and modified Shenling Baizhu powder. The changes of intestinal mucosal barrier function (intestinal mucosal permeability, negative rate of bacterial translocation index and concentration of C-reactive protein) were monitored in control group and treatment group before and after drug treatment, respectively. Statistical analysis of whether Chinese medicine has the role of protecting intestinal mucosal barrier. Results: compared with before treatment, the intestinal mucosal barrier function of the control group and the treatment group were protected, but the treatment group was superior to the control group in protecting the intestinal mucosal barrier function. The results were as follows: 1. Compared with the control group, the intestinal mucosal permeability index in the treatment group improved significantly (P0.05). 2, compared with the control group, the intestinal mucosal permeability index in the treatment group was significantly improved (P0.05), and compared with the control group (P0.05). The negative rate of bacterial translocation in the treatment group was higher than that in the control group (P0.05). 3. The concentration of C- reactive protein in the control group and the treatment group was significantly higher than that in the control group. The peak was reached at 24 hours after operation, and then decreased gradually. Compared with the control group, the concentration of C- reactive protein decreased significantly in the treatment group (P0.05). Conclusion: the results of this study indicate that, on the basis of enteral nutrition therapy "Ruisin", the treatment of modified Shenling Baizhu Powder for abdominal postoperative patients with traditional Chinese medicine can reduce the permeability index of intestinal mucosa (L _ (%) MN _ (D) -lactic acid). The change of (PCR), C reaction protein concentration of bacterial translocation index was better than that of control group. Therefore, it is considered that the treatment of modified Shenling Baizhu Powder after abdominal surgery has obvious curative effect on protecting intestinal mucosal barrier function, and the patients receiving the treatment have no adverse reactions, high safety, and can be widely popularized in clinical practice.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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