大黃對胃癌手術患者急性炎性反應的調理作用

1、大黃對胃癌手術患者急性炎性反應的調理作用         07-09-12 17:30:00     編輯：studa20         作者：蔡駿，宣正榮，衛(wèi)勇平，楊海波，王華【關鍵詞】  胃腫瘤    摘要  目的：觀察胃癌患者圍手術期使用中藥大黃對急性炎性反應的調理作用。方法：采用前瞻性、隨機、單盲、對照研究，將31例胃癌手術患者隨機分為對

2、照組（腸內營養(yǎng)組）14例和研究組（大黃加腸內營養(yǎng)組）17例。研究組術前、術后第1、2天經(jīng)鼻飼管給予中藥大黃，兩組患者手術后36 h開始給予等熱量、等氮腸內營養(yǎng)支持6 d。術前1天，術后第1、3、7天分別檢測血清C反應蛋白（Creactive protein, CRP）、白細胞介素6（interleukin 6, IL6）、腫瘤壞死因子（tumor necrosis factor, TNF）等急性炎性反應指標及血清白蛋白、前白蛋白、轉鐵蛋白等營養(yǎng)指標。結果：兩組患者術后均有急性炎性反應的發(fā)生及營養(yǎng)指標的下降，但研究組術后第3、7天的CRP、IL6、TNF水平較對照組有顯著下降，術后排氣、排便時間

3、和腸鳴音的恢復顯著提前。術后的營養(yǎng)指標兩組患者間無明顯差異。結論：胃癌患者圍手術期應用大黃可以緩解急性炎性反應，促進術后胃腸道功能恢復，有利于實施術后腸內營養(yǎng)支持。    關鍵詞  胃腫瘤; 大黃; 細胞因子; 腸道營養(yǎng)       Effects of perioperative administration of rhubarb on acute inflammatory response in patients with gastric cancer   &#

4、160; ABSTRACT  Objective:To observe the effect of perioperative administration of rhubarb on the acute inflammatory response in patients with gastric cancer. Methods: In this prospective, singleblinded, controlled clinical trial, thirtyone patients with gastric cancer operatively treated were r

5、andomly divided into two groups, with 14 patients in control group and 17 in study group. Patients in both groups were given an isocaloric and isonitrogenous enteral diet. The enteral diet was started 36 hours after operation, and continued for 6 days. Patients in the study group were fed with rhuba

6、rb before operation, and at 1 day and 2 days after operation. Indexes of acute inflammatory response such as serum Creactive protein (CRP), interleukin6 (IL6) and tumor necrosis factor (TNF), and indexes of nutritional status such as serum albumin (ALB), prealbumin (PA) and transferrin (TRF) were me

7、asured before operation, and at 1 day, 3 and 7 days after operation. Results: Patients in both groups had acute inflammatory response, and the indexes of nutritional status decreased after operation. IL6, CRP and TNF tested at 3 and 7 days after operation were lower in the study group as compared wi

8、th those in the control group, and the recovery time of gastrointestinal motility such as borborygmus, gas elimination and defecation was shorter in the study group as compared with that in the control group. The indexes of nutritional status showed no significant differences between two groups afte

9、r operation. Conclusion:Rhubarb can positively modulate the acute inflammatory response, promote the recovery of postoperative gastrointestinal motility, and benefit enteral nutrition support in patients who have undergone major operations for gastric cancer.    KEY WORDS  stomac

10、h neoplasms; Rheum palmatum; cytokines; enteral nutrition    胃癌患者常伴有營養(yǎng)不良，手術治療后，胃腸道功能處于一種抑制狀態(tài)，手術創(chuàng)傷誘導的急性炎性反應更加重了其營養(yǎng)不良。術后如何改善患者的營養(yǎng)狀況，糾正腫瘤和手術創(chuàng)傷所致的急性炎性反應，實施合理的營養(yǎng)支持成為近年來研究的熱點之一。針對胃癌患者圍手術期機體代謝的特點，本科在術后常規(guī)腸內營養(yǎng)治療的同時，采用具有清熱、解毒、抗炎、抗腫瘤等作用的中藥大黃有效地減輕了術后炎性反應，促進了胃腸道功能的恢復，有利于實施術后早期腸內營養(yǎng)支持，茲報告如下。 &#

11、160;  1  資料和方法    1.1  病例入選標準  選擇我院普外科2002年2月2004年1月間行胃癌手術的患者作為研究對象。所有患者無重要臟器功能不全，年齡3277歲，排除有遠處轉移行姑息性切除和無法切除者。所有入選病例均伴有營養(yǎng)不良。營養(yǎng)不良的標準：體質量比發(fā)病前6個月下降10%或體質指數(shù)（body mass index, BMI）<20。    1.2  病例分組  按患者入組先后順序編號，根據(jù)隨機數(shù)字表法分組。31名患者隨機分為2組：研究組（大黃和腸內

12、營養(yǎng)組）17例和對照組（腸內營養(yǎng)組）14例。兩組患者在性別、年齡、胃癌分期、手術方式、手術時間、麻醉方式、麻醉時間、輸血量、使用人體白蛋白量、使用抗生素量等方面均無統(tǒng)計學差異。    1.3  給藥方法和腸內營養(yǎng)支持方法  研究組和對照組患者術后腸內營養(yǎng)支持均通過在術中放置于胃空腸吻合口以下的鼻腸管或經(jīng)空腸造瘺管滴入紐迪希亞公司生產(chǎn)的能全力，術后36 h開始使用，即術后第2天100 ml（滴速50 ml/h），術后第3、4、5天250 ml（滴速80100 ml/h），第6天開始5001 000 ml（滴速100150 ml/h），持續(xù)6 d，用輸液泵均勻輸入。研究組在術前1天經(jīng)鼻飼管滴注大黃10 g（由本院中藥房自上?？禈蝻嬈邢薰举徣耄?次。大黃的給藥方法：將10 g大黃粉碎成粗粉，用100 沸水100 ml浸泡15 min，涼至3738 ，以20 ml/min速度滴入，閉管1