Rhein Blood Drug Concentration Change And The Study On The Relationship Between The Inflammatory Factors Of Acute Pancreatitis

Purpose:Clinical to observe the curative effect of rhubarb treatment of AP speculates that analysis of AP patients blood drug concentration change,rhein pharmacokinetic characteristics and prognosis of AP.Method:Use prospective,randomized,controlled clinical trial,collect in April 2015 to October 2015,nanchang university first affiliated hospital of the clinical data of patients of all MSAP,SAP in gastroenterology ICU,according to the inclusion criteria and exclusion criteria,A total of 59 cases,the random number table method is adopted in all patients admitted to hospital namely,rhubarb treatment group and magnesium sulfate in the control group.The two groups before treatment,two days,three days,seven days,fourteen days makes extraction of venous blood of interleukins-six,interleukins-eighteen,tumor necrosis factor-α,serum D-lactic acid,diamine oxidase,motilin,cholecystokinin.Rhubarb group in one hour,two hours,four hours,two days,seven days,fourteen days after treatment makes extraction of venous blood rhein blood drug concentration,statistics two groups patients the improved Marshall score,borborygmus,daily stool frequency,abdominal pressure and the incidence of abdominal interval syndrome(ACS),the incidence of infection,mortality,ICU stayed time,total length of hospital stay,the total cost of hospitalization.Results : First,the rhein blood peak concentration of SAP patients(2.41±0.99mg/L)significantly lower than the health volunteer(3.44±1.23mg/L),P<0.05;The time to peak concentration of SAP patients(1.97±0.49h)significantly longer than the health volunteer(1.40±0.55h),P < 0.05;Rhein blood drug concentration and IL-6(R=-0.726)、IL-18(R=-0.728)、TNF-α(R=-0.707)before treatment were significantly negative correlation;The time to rhein peak blood drug concentration and IL-6、IL-18、TNF-α before treatment has no relevance;Compared to two days after treatment with magnesium sulfate group,Rhubarb group of patients with AP IL-6(P<0.01)、IL-18(P<0.01)、TNF-α(P<0.01)is decreased obviously.Second,compared with magnesium sulfate group,rhubarb group two days after treatment,D-Lac,DAO significantly lower,MTL,CCK increased significantly;Rhein high steady blood drug concentration patients D-Lac,DAO level significantly lower than the rhein steady low blood drug concentration of patients;Rhein high steady blood drug concentration MTL,CCK level significantly higher than the rhein steady low blood drug concentration of patients.Third,Compared with magnesium sulfate group,two days after treatment,rhubarb group of patients improved Marshall breath and cardiovascular score lower,but no statistical significance;improved Marshall Kidney score no difference;Obviously increase the number of borborygmus;Stool frequency increased significantly;patients of rhein high steady blood drug concentration borborygmus,stool frequency significantly higher than the patients of rhein low steady blood drug concentration.Forth,three days after treatment complicated with infection were slightly less,but without statistical significance;seven days after treatment the incidence of ACS has no differences;fourteen days after treatment of two groups of gastrointestinal hormone,modified Marshall score,abdominal pressure,no difference or no statistical significance;No difference between the case fatality rate;ICU admission time,total shorten hospitalization time,total hospitalization cost is reduced,but no statistical significance.Conclusion:First,the peak concentration of the rhein in AP patients and proinflammatory factor levels was significantly negative correlation,time to peak has no correlation with proinflammatory factor;Second,the AP patients with proinflammatory factor concentration and rhein steady-state concentration has significant negative correlation;Thrid,use rhubarb for MSAP,SAP can protect the intestinal mucosal barrier,increase the secretion of gastrointestinal hormone and promote bowel sound recovery,increase defecation frequency,lower abdominal pressure;Forth,application of rhubarb treatment MSAP,SAP cannot reduce the modified Marshall score,cannot reduce the incidence of infection,the case fatality rate,cannot shorten ICU admission time,cannot shorten total length of hospital stay,cannot reduce total cost of hospitalization.