大黄联合肠内营养对胃癌围手术期患者外周血C反应蛋白和白细胞介素6水平的影响

目的 观察应用中药大黄和肠内营养对胃癌围手术期患者外周血C反应蛋白（C- reactive protein，CRP）、白细胞介素6（interleukin 6， IL-6）水平的影响。方法 将56例胃癌围手术期患者随机分为对照组20例，肠内营养组21例，大黄加肠内营养组15例。对照组术后常规补液的同时实施肠外营养支持；肠内营养组术后常规补液的同时术后42 h开始给予肠内营养液能全力鼻饲管滴入，一直持续到术后第8天；大黄加肠内营养组患者术前1天应用大黄液100 mL(10 g)，术后18 h、42 h各用大黄液50 mL(5g)，同时给予肠内营养液能全力。所有研究对象分别于手术前1天、手术后第1、3、7天检测血清CRP、IL-6。结果 3组患者术后均有急性炎症反应的发生，但大黄加肠内营养组术后第7天血浆CRP水平〔（12.67±4.28）mg/L〕和IL-6水平〔（18.17±11.10）mg/L〕均明显下降，与对照组〔（19.72±9.73）mg/L、（20.44±6.32）mg/L〕及肠内营养组〔（21.27±10.46）mg/L、（20.29±7.79）mg/L〕比较，差异均有统计学意义（P＜0.05）；大黄加肠内营养组肠鸣音的恢复较非大黄组提前。结论 胃癌患者围手术期应用大黄可以有效降低外周血CRP 、IL-6水平，缓解手术创伤引起的急性炎症反应,促进术后胃肠道功能恢复, 有利于实施术后肠内营养支持。

Effect of Rhubarb Combined with Enteral Nutrition on C-reactive Protein and Interleukin-6 in Peripheral Blood of Patients with Gastric Cancer during Perioperative Period

OBJECTIVE: To observe the effects of rhubarb and enteral nutrition on C-reactive protein (CRP) and interleukin-6 (IL-6) in peripheral blood of patients with gastric cancer during perioperative period. METHODS: Fifty-six patients with gastric cancer were randomly assigned to three groups. The 20 patients in Group A were given conventional fluid supplement and parenteral nutrition; the 21 patients in Group B were given conventional fluid supplement and enteral nutrition via nasal feeding starting from the 42nd hour to the 8th day after operation; and the 15 patients in Group C were treated, besides the same fluid supplement and enteral nutrition as that for Group B, with additional three times of 10% rhubarb liquid medication, given at the day before operation (100 mL), and the 18th and 42th hour post-operation (50 mL in each time). Serum levels of CRP and IL-6 of all patients were measured at different time points, i. e. the day before operation (T0), the 1st (T1), 3rd (T2) and 7th day (T3) after operation. RESULTS: Acute inflammatory reaction happened in all the patients. However, the plasma level of CRP and IL-6 in Group C at T3 (12.67 +/- 4.28 mg/L and 18.17 +/- 11.10 mg/L) was significantly lower than those in Group A (19.72 +/- 9.73 mg/L and 20.44 +/- 6.32 mg/L) and Group B (21.27 +/- 10.46 mg/L and 20.29 +/- 7.79 mg/L), respectively (P < 0.05). And the recovery time of borborgmus in Group C were the shortest among the three groups. CONCLUSION: Applying rhubarb on gastric cancer patients during perioperative period can effectively decrease the levels of CRP and IL-6 in peripheral blood, alleviate acute inflammatory reaction caused by operative trauma, promote the recovery of postoperative gastrointestinal motility and be beneficial for the supplement of enteral nutrition.