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目的观察卡巴胆碱联合黄连素治疗创伤后肠功能障碍的临床疗效。方法 60例严重创伤患者随机分为试验组和对照组,各30例。对照组经胃管注入卡巴胆碱0.2 mg·kg~(-1),每天2次。试验组在对照组基础上加用生大黄粉20 g,温开水50 mL调匀后经胃管注入,每天2次。2组疗程均为7 d。观察2组患者的临床疗效、多器官功能障碍综合征(MODS)发生率、病死率。分别于治疗前、治疗后晨起对患者进行胃肠功能障碍评分、急性生理及慢性健康状况(APACHEⅡ)评分、MODS评分,测定二胺氧化酶、白细胞介素-6(IL-6)和胃动素水平。结果治疗后,试验组总有效率显著高于对照组(P<0.05)。试验组MODS发生率、病死率均显著低于对照组(P<0.05)。治疗后,试验组胃肠功能障碍评分、APACHEⅡ评分、MODS评分均较对照组显著降低(P<0.05)。治疗后,试验组的二胺氧化酶、IL-6水平较对照组显著降低(P<0.05);试验组的胃动素水平较对照组显著提高(P<0.05)。结论卡巴胆碱联合大黄能明显改善肠功能障碍,特别是肠屏障功能障碍,能抑制炎症反应,取得良好的临床疗效,改善重症患者的预后。
Objective To observe the clinical efficacy of carbachol combined with berberine in the treatment of post-traumatic intestinal dysfunction. Methods Sixty patients with severe trauma were randomly divided into experimental group and control group, with 30 cases in each group. The control group was injected carbachol 0.2 mg · kg ~ (-1) via gastric tube twice a day. The experimental group in the control group based on the use of raw rhubarb powder 20 g, 50 ml of warm water and mix thoroughly through the tube into the stomach, 2 times a day. The two courses of treatment were 7 days. The clinical efficacy, morbidity and mortality of multiple organ dysfunction syndrome (MODS) in two groups were observed. The scores of gastrointestinal dysfunction, acute physiology and chronic health status (APACHEⅡ) and MODS were measured before treatment and after treatment respectively. The levels of diamine oxidase, interleukin-6 (IL-6) and gastric Momentum level. Results After treatment, the total effective rate of the experimental group was significantly higher than that of the control group (P <0.05). The morbidity and mortality of MODS in the experimental group were significantly lower than those in the control group (P <0.05). After treatment, the gastrointestinal dysfunction score, APACHEⅡscore and MODS score in the experimental group were significantly lower than those in the control group (P <0.05). After treatment, the levels of diamine oxidase and IL-6 in the experimental group were significantly lower than those in the control group (P <0.05). The levels of motilin in the experimental group were significantly higher than those in the control group (P <0.05). Conclusion Combined carbachol and rhubarb can significantly improve intestinal dysfunction, especially intestinal barrier dysfunction, can inhibit the inflammatory response, achieved good clinical efficacy and improve the prognosis of critically ill patients.