大黄灌肠治疗慢性肾功能衰竭氮平衡研究

作者	单位
毕增祺	北京协和医院内科肾脏病组
郑法雷	北京协和医院内科肾脏病组
胡红宇	北京协和医院内科肾脏病组
崔月荣	北京协和医院营养部

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中文摘要:

本文对大黄灌肠治疗慢性肾功能衰竭进行了氮平衡研究,5例患者治疗后,血尿素氮下降;平均粪氮含量增加;尿尿素氮下降;氮平衡和校正氮平衡有所降低,维持氮有所增加,但后三者变化均不显著。提示大黄灌肠有增加氮代谢产物排泄作用。

英文摘要:

It is known that uremic toxic substance can be excreted by Gl tract,Recent reports suggested that blood urea nitrogen(BUN)of uremic patients was lowered by diarrhea with rhubarb.In order to evaluate the effectiveness and mechanism of rhubarb on uremia,the nitrogen balance(NB)in five uremic patients treated with rhubarb were studied.All these patients were in stable condition.Their Ccr was 8.70±5.40 ml/min,Scr 10.90±6.90 mg/dl,BUN 75.20±41.50 mg/dl.The treatment was divided into two stages:(1) Control(14.20±3.70 days):Average protein intake was 34.80 g/day.NB was studied for 52±1.3 days.(2) Treatment with rhubarb(12.4±3.1 days):Average protein intake was similar to that of control.Retention enema with 10 g/day of rhubarb powder added to 500～700 ml/day of water was used.NB was studied for 5.0±1.2 days.Results:(1)After treatment with rhubarb,BUN was lowered from 62.80±35.50 mg/dl to 45.00±38.20 mg/dl(P<0.05).No changes of Ccr and Scr were found.(2)Average feces nitrogen(FN) during treatment with rhubarb was increased from 1.56 g/day(control)to 2.35 g/day(P<0.02).Urine nitrogen(UN)was decreased by 0.30 g/day(from 3.58±0.49 g/day to 3.32±0.67 g/day,P<0.05).(3)NB during rhubarb treatment was lower than control(+0.14±0.85 g/day vs+0.52±1.06 g/day.P<0.05). These results suggested that rhubarb retention enema on reduction of BUN was effective and this effectiveness might be related to decrease of FN by the drug.Because of NB change,the rhubarb treatment might exert harmful effect on the protein metabolism of uremic patients.

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