不同剂量生大黄粉防治危重病患者胃肠并发症的临床研究

目的 研究不同剂量生大黄粉在防治危重病患者胃肠并发症中的临床价值.方法 选择深圳市龙岗区人民医院2012年6月～2013年5月收治的60例危重病患者作为研究对象,随机分为小剂量组、大剂量组、对照组,小剂量组给予0.05 g/（kg·次）生大黄粉灌胃治疗,大剂量组给予1.5 g/（kg·次）大黄粉灌胃治疗,对照组给予营养支持、容量支持及抗感觉治疗;观察急性生理和慢性健康状况评分（APACHEⅡ）、炎症指标、肾功能情况以及总体病情.结果 治疗后5d大剂量组APACHEⅡ评分（24.48±3.75）分]、降钙素（32.7±5.5）ng/L]、乳酸（0.98±0.11） mmol/L]、C-反应蛋白（6.8±1.1）mg/L]、白细胞介素（IL）-6（0.22±0.05）μg/L]、IL-8（10.3±1.6） μg/L]以及血肌酐（142.9±20.5）μmol/L]、血尿素氮（8.3±1.4） μmol/L]、24 h尿蛋白水平（0.19±0.03）g]以及大便次数（1.84±0.23）次]、总住院日（12.92±2.21）d]、多器官功能障碍综合征（MODS）的发生例数2（10％）]、脏器受累数（0.83±0.11）个]均明显低于小剂量组和对照组（P＜0.05）;血红蛋白（121.4±19.4）g/L]、内生肌酐清除率（101.8±15.4）mL/min]、抢救成功例数20（100％）]明显高于对照组（P＜0.05）;治疗后1、3、5d三组APACHEⅡ评分、降钙素、乳酸、C-反应蛋白、IL-6、IL-8以及血肌酐、血尿素氮、24 h尿蛋白水平以及大便次数、总住院日、MODS的发生例数、脏器受累数呈现出大剂量组＜小剂量组＜对照组;血红蛋白、内生肌酐清除率均呈现出大剂量组＞小剂量组＞对照组.结论 大剂量生大黄粉灌胃治疗能够降低APACHEⅡ评分、控制炎症反应、改善肾功能、促进病情恢复,具有积极的临床价值.

Clinical study of different doses of raw rhubarb powder in the treatment of critical patients with gastrointestinal complications

Objective To study clinical value of different doses of raw rhubarb powder in the treatment of critical patients with gastrointestinal complications.Methods 60 cases of critical patients in Longgang District People＇s Hospital of Shenzhen from June 2012 to May 2013 were randomly divided into low dose group,high dose group,control group,low dose group were given 0.05 g/（kg ·times） rhubarb gavage treatment,high dose group was given 1.5 g/（kg·times）rhubarb gastric lavage treatment,control group received nutritional support,support capacity; APACHE] score,inflammation index,renal function and overall condition were observed.Results After treatment of 5 d,APACHE score （24.48±3.75） points],calcitonin （32.7±5.5） ng/L],lactic acid （0.98±0.11） mmol/L],C-reactive protein （6.8±1.1） mg/L],IL-6 （0.22±0.05） μg/L],IL-8 （10.3±1.6） μg/L] and serum creatinine （142.9±20.5） μmol/L],blood urea nitrogen （8.3±1.4） μmol/L],24 h urine protein level （0.19±0.03） g],stool frequency （1.84±0.23） times],the total length of stay （12.92±2.21） d],MODS cases 2 （10％）],the number of organ involvement （0.83±0.11） of high dose group were significantly the low dose group and control group （P ＜ 0.05）; hemoglobin （121.4±19.4） g/L],endogenous creatinine clearance rate （101.8±15.4） mL/min],the successful rescue cases 20 （100％）] were significantly higher than the control group （P ＜ 0.05）; after treatment 1,3,5 d,APACHE I] score,calcitonin,lactic acid,C-reactive protein,IL-6,IL-8 and serum creatinine,blood urea nitrogen,24 h urinary protein levels and defecate number,total such confinement,the occurrence of MODS cases,the number of organs involved showed：high-dose group ＜ low dose group ＜ control group; hemoglobin,endogenous creatinine clearance showed：high-dose group ＞ low dose group ＞ control group.Conclusion High doses of raw rhubarb powder treatment can reduce APACHE Ⅱ score,control inflammation,improve renal function,promote clinical progress,have positive clinical value.