固脱清腑汤胃肠道灌注对重症多发伤患者血液细菌16S rRNA的影响

作者	单位
张竝	浙江省立同德医院
王伟	浙江省立同德医院
张庚	浙江省立同德医院
俞勇	浙江省立同德医院
金冶	浙江省立同德医院
陈扬波	浙江省立同德医院
陈云	浙江省立同德医院
蔡乾荣	浙江省立同德医院
詹元起	浙江省立同德医院
周钰	浙江省立同德医院

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中文摘要:

目的观察固脱清腑汤早期胃肠道灌注对重症多发伤患者血液细菌16S rRNA基因的影响。方法 60例严重多发伤患者分为治疗组(33例)和对照组(27例),伤后两组经胃肠营养管分别滴入自拟中药汤剂固脱清腑汤和生理盐水,两组其余治疗原则相同。观察两组患者伤后第3、6、9天的血细菌16S rRNA基因阳性率、体温、白细胞计数、血清超敏C反应蛋白(CRP)、血培养阳性率、感染性并发症的发生率和病死率。结果治疗组伤后第9天体温[(37.6±0.12)℃]显著低于对照组[(38.10±0.15)℃,P<0.05];伤后第6、9天CRP治疗组分别为(52.4±6.3)mg/L和(42.9±7.5)mg/L,显著低于对照组[分别为(104.3±20.1)mg/L和(92.5±17.1)mg/L,均为P<0.05];伤后第6、9天血细菌16S rRNA基因阳性率分别为33.3%和30.3%,显著低于对照组(分别为59.3%和77.8%),差异均有统计学意义(P<0.05,P<0.01);伤后血培养结果两组差异无统计学意义(P>0.05);治疗组感染性并发症的发生率(30.3%)也显著低于对照组(59.3%,P<0.05)。结论固脱清腑汤早期胃肠道灌注可能有益于严重创伤患者肠黏膜屏障功能的改善,对减少肠道细菌易位,降低感染性并发症的发生率有一定的作用。

英文摘要:

Objective To observe the effects of Gutuo Qingfu Decoction (GQD) via gastro-enteric perfusion on blood level of bacterial 16S rRNA gene in severe multi-traumatic (SMT) patients at early stage.Methods Sixty SMT patients were assigned to two groups,the 33 in the treated group and the 27 in the control group. They were treated with the same conventional treatment,but different in the gastro-enteric infusion with GOD for the former and saline for the latter. Blood 16SrRNA gene,body temperature,leukocyte count,C-reactive protein (CRP),and blood bacterial culture positive rate on the 3,6,9 post-trauma days were detected,and incidences of infective complication and mortality were observed. Results Body temperature on day 9 in the treated group was significantly lower than in the control group (37.6±0.12 ℃ vs 38.1±0.15 ℃,P<0.05); so did the CRP level on day 6 (52.4±6.3 mg/L vs 104.3±20.1 mg/L,P<0.05) and day 9 (42.9±7.5 mg/L vs 92.5±17.1 mg/L,P<0.05),as well as the positive rates of blood 16SrRNA gene on day 6 and 9 (33.3% vs 59.3% and 30.3% vs 77.8%,P<0.05 and P<0.01,respectively). However,the positive rates of blood culture were insignificantly different between the two groups (P>0.05). Besides,incidence of infective complication in the treated group was significantly lower than in the control group (30.3% vs 59.3%,P<0.05). Conclusion Early stage gastrointestinal administration of GQD is likely to have benefits for the improvement of intestinal mucosa barrier and reduction of enteric bacterial translocation in SMT patients,and it may also reduce the incidence of infective complication in these patients.

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