生大黄并微生态制剂肠营养对多发伤患者肠屏障功能的影响

目的探讨强化生大黄并微生态制剂的肠内营养对严重多发伤后肠道屏障功能的影响。方法创伤严重度评分（ISS）〉20分的严重多发伤患者82例，随机分为强化治疗组（41例）和常规治疗组（41例），常规治疗组给予常规治疗，强化治疗组在常规治疗基础上，早期即用生大黄并微生态制剂肠内营养强化治疗。分别于治疗前1d和治疗后第8天，测定两组患者外周血D-乳酸、肿瘤坏死因子-α（TNF—α）、白细胞介素～6（IL-6）水平变化，并进行比较；28d后均观察脓毒症发生比率及多器官功能障碍综合征（MODS）发生率、病死率。结果两组患者在治疗前外周血清D-乳酸、TNF-α、IL-6水平比较差异无统计学意义（P〉0．05），治疗8d后，强化治疗纽较常规治疗组降低更显著，差异均有统计学意义（P〈0．05）；脓毒症发生率：强化治疗纽31．70％（13例）．常规组68．29％（28例），差异有统计学意义（P〈0．01）；MODS发生率：强化治疗组24．39％（10例）．常规组60．97％（25例），差异有统计学意义（P〈0．01）；病死率：强化治疗组12．19％（5例），常规组41．46％（17例），差异均有统计学意义（P〈0．01）。结论严重多发伤患者强化给予生大黄应用并及时微生态制剂肠内营养治疗，维护肠屏障功能，阻止肠道细菌移位、内毒素入血，降低了脓毒症、MODS发生率及病死率。

Influence of intestinal barrier in severe multiple trauma patients by the early treatment of rhubarb and microecopharmaceutics - supplemented enteral nutrition

Objective To study the influence of intestinal barrier in severe multiple trauma patients by the early treatment of rhubarb and microecopharmaceutics - supplemented enteral nutrition. Methods Eighty -two muhiple trauma patients injury severity score （ISS） 〉 20 ] were selected. Eighty -two patients in severe multiple trauma who were assigned randomly to combined treatment group or control group. The patients in control group were treated with classical therapy, those in combined treatment group were infused with the rhubarb and microecopharmaceutics - supplemented enteral nutrition. Blood samples were collected 1 and 8 day after trauma for plasma levels of D - lactate, and the plasma contents of TNF - α, IL - 6 were determined. Meanwhile, the mortality of sepsis and muhiple organ dysfunction syndrome （MODS） , the morbidity of detection within 28 days. Results Results were found in those were early treated with patients in the combined treatment, 8 days after trauma for plasma levels of D - lactate, TNF -α, IL - 6 were determined increased significantly than that in control group （P 〈0.05） ; Within 28 days mortality of sepsis in 12 patients （29.26%） （P 〈0.01 ）, MODS in and the prognosis.