乌司他丁对腹部创伤患者围术期肠粘膜屏障功能的影响

目的研究乌司他丁对腹部创伤患者围术期肠粘膜屏障功能的影响。方法60例行急诊剖腹探查的腹部创伤患者随机分为两组：乌司他丁组（U组），切皮前用乌司他丁20万U溶于100ml0．9％生理盐水中静脉注射，每24h1次，连续3d；对照组（C组）则以等量生理盐水作为安慰对照。分别于手术后12、24、48、72h测定两组患者尿乳果搪与甘露醇的比值（L／M）、血浆二胺氧化酶（DAO）、内毒素（ET）、肿瘤坏死因子（TNF-α）及免疫球蛋白A（IgA）。结果两组患者术后L／M、DAO、ET、TNF-α进行性升高，IgA则逐步降低；与C组比较，U组患者L／M、DAO、ET、TNF—α值于术后24h、48h、72h明显降低（P〈0．05），IgA明显升高（P〈0．05）。结论围术期应用乌司他丁通过改善肠道粘膜通透性对腹部创伤患者肠粘膜屏障功能具有明显保护作用，对预防创伤引起的肠道细菌内毒素移位具有重要临床意义。

Effects of ulinastatin on intestinal mucosa barrier in patients with abdominal trauma

Objective To explore the effects of ulinastatin on intestinal mucosa barrier in patients with abdominal trauma. Methods Sixty patients with abdominal trauma undergoing exploratory laparatory were randomly divided into treatment group （ U group） and control group（ C group）. The ulinastatin of 0. 2 million unit was used consecutive 3-day by i. v. dripper in the U group after induction of anesthesia. The saline solution was given respectively in C group. The ratio of lactulose to marmitol （ L/ M）, plasma level of TNF-α, diamine oxidase （DAO）, endotoxin （ET） and IgA of the two groups on the post-operation 12hours, 24hours,48hours and 72hours. Results The levels of L/M, DAO,TNF-α and ET were progressively increased while the level of lgA was decreased gradually after operation in the two groups. The levels of L/M,DAO,TNF-α and ET in the U group were obviously lower than that in the C group on each time（P〈0. 05）. The levels of IgA were increased in the U group compared with the C group on each time（P〈0. 05）. Conclusion Ulinastatin can protect the intestinal mucosa barrier in patients with abdominal trauma.