摘要
目的:探讨别嘌呤醇和维生素C对严重创伤后胃黏膜损伤的防治作用及其机制。方法:选择严重创伤骨折合并失血性休克患者120例,按照随机数字表法将其分为对照组(C组)、别嘌呤醇组(ALO组)和维生素C组(VC组),每组40例。比较3组患者入院后6 h(T0)、2 d(T1)、4 d(T2)、7 d(T3)、14 d(T4)和术后2 d(T5)血清TXB2、PGE2、NO和MDA含量,观察记录胃黏膜损伤分级及临床归转、结局情况。结果:与C组比较,ALO组和VC组血清TXB2及MDA含量降低、PGE2及NO含量升高,与ALO组比较,T1、T2和T3时间点VC组血清TXB2和MDA含量降低、PGE2和NO含量升高(P<0.01和P<0.05);与C组比较,T2和T3时间点内镜下胃黏膜损伤0/1/2级患者例数增加、3/4级患者例数降低(P<0.01和P<0.05);与C组比较,ALO组未发生SU的比例于T3及T4时间点增加,发生SU比例于T3及T4时间点降低,VC组未发生SU比例于T2、T3、T4及T5时间点增加,发生SU比例于T2、T3、T4及T5时间点降低(P<0.05和P<0.01),ALO组与VC组未发生SU及发生SU患者的比例比较差异无统计学意义(P>0.05)。结论:别嘌呤醇和维生素C可通过抑制脂质过氧化、改善胃黏膜血流、保护血管内皮及胃黏膜细胞等机制,减轻或延缓氧化应激和缺血再灌注损伤引发的急性应激性胃黏膜损伤。维生素C抗胃黏膜氧化损伤的作用好于别嘌呤醇。
Objective:To investigate the effects of allopurinol and vitamin C on gastric mucosal lesion induced by severe trauma.Methods:120 patients with severe polytrauma and hemorrhagic shock were randomly divided into 3 groups(n=40 each):control group(group C),allopurinol group(group ALO)and vitamin C group(group VC).The three groups were observed and compared 6h(T0),2 days(T1),4 days(T2),7 days(T3),14 days(T4)after admission to hospital and 2 days(T5)after surgery in terms of contents of serum TXB2,PGE2,NO and MDA respectively.The grade of gastric mucosal lesions was observed and the pathologic changes were evaluated.Results:Compared with group C,serum TXB2 and MDA contents in groups ALO and VC were decreased,and PGE2 and NO contents were increased(P<0.01 or P<0.05).Compared with group ALO,serum TXB2 and MDA contents were declined,while PGE2 and NO contents were increased at T1,T2 and T3 in group VC(P<0.01 or P<0.05).Compared with group C,grades 0/1/2 gastric mucosal lesions were increased and grades 3/4 gastric mucosal lesions were decreased at T2 and T3 in groups ALO and VC(P<0.01 or P<0.05).Compared with group C,the constituent ratios of patients without SU were increased and patients with SU were decreased at T3 and T4 in group ALO;while the constituent ratios of patients without SU were increased and patients with SU were decreased at T2,T3,T4 and T5 in group VC(P<0.05 or P<0.01).Compared with group ALO,no significant was found in the constituent ratios of patients without SU and patients with SU in group VC(P>0.05).Conclusion:Allopurinol and vitamin C can alleviate acute gastric mucosal lesion induced by severe multiple trauma.The main mechanism may include reducing lipid peroxidation,ameliorating gastric mucosal blood flow and cellular energy metabolism.Additionally,the protective effect of vitamin C on acute gastric mucosal lesion is better than allopurinol.
作者
汪涛
周业庭
朱安祥
陈新年
周巧林
WANG Tao;ZHOU Yeting;ZHU An-xiang;CHEN Xin'nian;ZHOU Qiaolin(Department of Anesthesiology,The Affiliated Shuyang Hospital of Xuzhou Medical University,Shuyang,Jiangsu 223600,China)
出处
《淮海医药》
CAS
2021年第6期571-575,共5页
Journal of Huaihai Medicine
基金
江苏省“333工程”科研项目资助计划(BRA2015243)。
关键词
胃黏膜损伤
别嘌呤醇
维生素C
抗氧化治疗
氧化应激
Gastric mucosal injury
Allopurinol
Vitamin C
Antioxidant therapy
Oxidative stress
