乌司他汀对肠手术创伤后肠黏膜屏障功能影响研究.doc

乌司他汀对肠手术创伤后肠黏膜屏障功能影响研究[摘要] 目的 观察乌司他汀对肠手术患者术后肠黏膜屏障功能的影响。方法 2010年1~12月本院普外科行肠手术患者80例，随机分为乌司他汀低剂量组和乌司他汀高剂量组各40例。手术前及手术后两组分别静脉滴注乌司他汀20万U/d和10万U/d。分别于手术前、手术后2、4天测定两组患者尿乳果糖与甘露醇的比值（L/M）、血浆谷氨酰胺（Gln）、外周血细菌DNA。结果 两组患者术后L /M、Gln逐渐升高，外周血细菌DNA阳性率逐渐降低（P＜0.05）；两组间差异具有统计学意义（P＜0.05）。结论 乌司他汀通过改善肠道黏膜通透性、升高Gln，对肠手术患者肠黏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移位具有重要临床意义。 [关键词] 肠黏膜屏障；乌司他汀；肠手术 [中图分类号] R65 6[文献标识码] B [文章编号]1673-9701（2011）21-34-02 Effects of Ulinastatin on Intestinal Mucosa Barrier in Patients with Intestinal Surgery YING Yanghuo Zhejiang Province Cixi City Longshan Public Health Center , Cixi 315326, China [Abstract] Objective To investigate the effects of ulinastatin on intestinal mucosa barrier in patients with intestinal surgery. Methods Eighty patients with intestinal surgery who visited general surgery department from January 2010 to December 2011 were randomly divided into low dosage group and high dosage group 40 cases in each group. Cases in low dosage group or in high dosage group received 200000 U or 100000 U of ulinastatin daily before and after operation. Ratio of lactulose and mannitol in urine (L/M), glutamine level in plasma and DNA in peripheral blood were determined before operation，2nd and 4th day after operation. Results L/M and glutamine level in plasma were gradually increased and DNA in peripheral blood was decreased after operation （P＜0.05）, and there were significantly different in both groups（P＜0.05）. Conclusion Ulinastatin can protect the intestinal mucosa barrier by improving the permeability of intestinal mucosa and increase glutamine level in plasma, and prevent the endotoxin translocation from intestine caused by trauma. [Key words] Intestinal mucosa barrier; Ulinastatin; Intestinal surgery 严重创伤和手术等应激状态造成的血流动力学的剧烈改变以及缺血再灌注均可损害肠黏膜屏障、诱导肠道细菌移位，并由此诱发全身炎症反应综合征、脓毒症、多器官功能障碍综合征，甚至死亡[1]。乌司他汀为蛋白水解酶抑制剂，作为免疫调节剂在临床上应用广泛[2]。动物实验显示，乌司他汀对梗阻性黄疸以及缺血再灌注大鼠的肠黏膜屏障功能具有改善作用[3,4]。本文研究乌司他汀对肠手术患者肠黏膜屏障功能保护作用进行研究，现报道如下。 1资料与方法 1.1一般资料 2010年1 ～12月本院普外科择期进