發(fā)布時間：2019-01-20 08:10

【摘要】：目的：腸道作為消化吸收營養(yǎng)物質的重要場所,在免疫系統(tǒng)調節(jié)方面也具有至關重要的作用。關于創(chuàng)傷、休克或腫瘤的多項研究說明,腸道粘膜組織在應激條件下,會發(fā)生一系列的形態(tài)學和功能學的改變,造成其屏障功能受損,進而易引起腸源性感染。腹部術后的患者處于一種應激環(huán)境中,其腸道粘膜的屏障功能受到一定的損傷,是否可以有效保護患者的腸粘膜屏障功能,直接關系到患者術后的康復以及生活質量。目前關于如何保護腹部術后患者的腸粘膜屏障功能的臨床研究和動物實驗研究不在少數(shù),但是研究中醫(yī)藥對于腹部術后患者腸粘膜屏障功能的研究仍很少。所以,本研究旨在通過手術前后監(jiān)測有關腸粘膜屏障功能的相關生化指標的變化,來進行加味參苓白術散對腹部術后保護腸粘膜屏障功能的臨床研究。方法：選擇近2年在我院外科病房需實行腹部手術治療的60例患者作為研究對象,經抽簽簡單隨機分為對照組和治療組各30例。對照組給予腸內營養(yǎng)用藥“瑞素”合谷氨酰胺顆粒治療,治療組給予腸內營養(yǎng)用藥“瑞素”合加味參苓白術散治療。分別監(jiān)測對照組和治療組在藥物治療前后的腸道粘膜屏障功能相關指標的變化(腸粘膜通透性、PCR檢測細菌易位指標轉陰率、C-反應蛋白濃度),進行統(tǒng)計分析中醫(yī)藥是否具有保護腸粘膜屏障的作用。成果：與治療前相比,對照組和治療組患者在給予不同藥物治療后腸粘膜屏障功能都得到了一定的保護,但治療組在保護腸粘膜屏障功能的方面明顯優(yōu)于對照組,具體腸粘膜屏障功能指標檢測結果分析如下：1、治療組在腹部術后腸黏膜通透性指標較對照組有明顯改善,差異有顯著性意義(P0.05)。2、與對照組比較,腹部術后治療組細菌易位指標轉陰率上升更明顯,差異有顯著性意義(P0.05)。3、對照組和治療組患者腹部術后C-反應蛋白的濃度指標明顯上升,且在術后24小時達到最高,隨后逐漸下降；與對照組比較,術后治療組C-反應蛋白濃度指標下降更明顯,差異有非常顯著性意義(P0.05)。結論：本研究結果表明,在腸內營養(yǎng)用藥“瑞素”治療的基礎上給予腹部術后患者加味參苓白術散的中醫(yī)藥治療,對于降低腸粘膜通透性指標(L/M、D-乳酸)、細菌易位指標轉陰率(PCR)、C反應蛋白濃度的變化具有明顯作用,其療效明顯優(yōu)于對照組。因此,認為給予腹部術后患者加味參苓白術散治療對于保護腸粘膜屏障功能具有明顯療效,且接受治療的患者未發(fā)現(xiàn)不良反應,安全性高,可在臨床廣泛推廣。
[Abstract]:Objective: as an important place for digestion and absorption of nutrients, intestinal tract also plays an important role in the regulation of immune system. Many studies on trauma, shock or tumor show that a series of morphological and functional changes occur in intestinal mucosal tissue under stress, which results in impaired barrier function and may lead to enterogenic infection. Patients after abdominal surgery are in a stress environment, the intestinal mucosal barrier function is damaged, whether can effectively protect the intestinal mucosal barrier function, directly related to postoperative rehabilitation and quality of life. At present, there are many clinical and animal studies on how to protect the intestinal mucosal barrier function of patients after abdominal surgery, but there are few researches on the intestinal mucosal barrier function of patients after abdominal surgery with traditional Chinese medicine. Therefore, the purpose of this study was to monitor the changes of biochemical indexes related to intestinal mucosal barrier function before and after operation, and to carry out the clinical study on the protection of intestinal mucosal barrier function after abdominal operation by modified Shenling Baizhu Powder. Methods: sixty patients who needed abdominal operation in surgical ward of our hospital in recent 2 years were selected as the research objects. The patients were divided into control group and treatment group by drawing lots. The control group was treated with enteral nutrition "Ruisin" combined with glutamine granules, and the treatment group was treated with enteral nutrition drug "Ruisu" and modified Shenling Baizhu powder. The changes of intestinal mucosal barrier function (intestinal mucosal permeability, negative rate of bacterial translocation index and concentration of C-reactive protein) were monitored in control group and treatment group before and after drug treatment, respectively. Statistical analysis of whether Chinese medicine has the role of protecting intestinal mucosal barrier. Results: compared with before treatment, the intestinal mucosal barrier function of the control group and the treatment group were protected, but the treatment group was superior to the control group in protecting the intestinal mucosal barrier function. The results were as follows: 1. Compared with the control group, the intestinal mucosal permeability index in the treatment group improved significantly (P0.05). 2, compared with the control group, the intestinal mucosal permeability index in the treatment group was significantly improved (P0.05), and compared with the control group (P0.05). The negative rate of bacterial translocation in the treatment group was higher than that in the control group (P0.05). 3. The concentration of C- reactive protein in the control group and the treatment group was significantly higher than that in the control group. The peak was reached at 24 hours after operation, and then decreased gradually. Compared with the control group, the concentration of C- reactive protein decreased significantly in the treatment group (P0.05). Conclusion: the results of this study indicate that, on the basis of enteral nutrition therapy "Ruisin", the treatment of modified Shenling Baizhu Powder for abdominal postoperative patients with traditional Chinese medicine can reduce the permeability index of intestinal mucosa (L _ (%) MN _ (D) -lactic acid). The change of (PCR), C reaction protein concentration of bacterial translocation index was better than that of control group. Therefore, it is considered that the treatment of modified Shenling Baizhu Powder after abdominal surgery has obvious curative effect on protecting intestinal mucosal barrier function, and the patients receiving the treatment have no adverse reactions, high safety, and can be widely popularized in clinical practice.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656

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