| BACKGROUND AND OBJECTIVESThe theory of traditional Chinese medicine dose due to a lack of systematic, connotation, its guidance for clinical practice is very limited, also has restricted the development of traditional Chinese medicine and its industrialization. Scientifically, therefore, in this paper, the dose effect relationship, the systematic research, summarizes the theory of traditional Chinese medicine dose to enhance the clinical curative effect of traditional Chinese medicine, and to guide clinical rational selection dose, is of great significance to the safe and effective medication.Raw rhubarb is one of the commonly used in clinical medicine, start record in the Eastern Han Dynasty, "Shen Nong’s Herbal Classic", its features include bitter, cold, active blood, remove to petechiae, dampness jaundice under diarrhea, heat purging fire and so on.In recent years, many studies have shown that affect gastrointestinal movement effects of rhubarb, also help to protect the reasonable application of intestinal barrier function and the prevention and control of the intestinal microflora shift, 1) rhubarb effect mucosal barrier and the mechanism of bacterial translocation in:(1) to improve blood flow perfusion of the gastrointestinal mucosa(2) the anti oxygen free radicals, reducing the gastrointestinal tract of ischemia-reperfusion injury(3) the influence of inflammatory mediators, rhubarb for endotoxin of antagonism between biological activities have a certain degree, can also reduce synthesis and release of cytokines and inflammatory mediators,such as CRP, IL- 6, TNF-α, NO and so on. Also can inhibit macrophage leukotriene C4, biosynthesis of leukotriene B4, also inhibit endotoxin stimulated macrophages in Ca2 + increases, thereby increasing intracellular c AMP levels increase(4) promote the secretion of intestinal mucous and immune substances(5) rhubarb for many gram-positive and gram-negative bacteria such as e. coli, fragile coli, staphylococcus aureus, etc all have certain inhibition, the main antibacterial ingredients as rhein, emodin and aloe emodin.(6) small doses of rhubarb can promote gastric mucosa epithelial cell growth. The impact of rhubarb on gastrointestinal dysfunction mechanism: the rhubarb in effect is the main active ingredients combined with sexual anthraquinone derivatives and double anthracene ketone, especially of double anthrone senna glycosides. Under the purging effect of associated with the following mechanisms:(1) on the intestinal smooth muscle of M receptor, accelerate the intestinal peristalsis.(2) inhibit intestinal membrane Na + /k + atpase activity, which hindered the Na + transport absorbed, thus higher osmotic pressure inside the lumen and retain a large number of moisture, speed up the intestinal peristalsis and defecation.Gastrointestinal tumor surgery stress caused by major surgery, severe trauma can cause gastrointestinal mucosa edema, erosion, ulceration, imbalance of micro ecological environment in the gastrointestinal tract, certain pathogens upward migration of the digestive tract and a large number of breeding, in the case of gastrointestinal mucous membrane barrier dyke break, a large number of bacteria and toxins in the body, which affects the patient’s postoperative rehabilitation. Clinical gastrointestinal cancer patients often due to anesthesia and postoperative stress may lead to a temporary gastrointestinal dysfunction, such as gastrointestinal peristalsis stop or reduced, abdominal distension,vomiting, even in secondary abdominal cavity infection in severe toxic intestine paralysis.Virtues in current in view of the above raw rhubarb, beneficial to the gastrointestinal cancer patients’ rapid recovery, in recent years there have been many articles have confirmed raw rhubarb stimulates recovery of gastrointestinal tract, my teacher also works published in 2011, confirmed the raw rhubarb nasogastric application in postoperative gastric cancer patients with fast track surgery, but the raw rhubarb dose for promoting the effect of the recovery of gastrointestinal function and there is no relevant research, our purpose of this issue is to solve the raw rhubarb dose in promoting the recovery of gastrointestinal function of patients within gastrointestinal tumor, and the impact on the postoperative inflammatory reaction and immune function. Preliminary estimate how should use the number of days and should be used daily doses can get satisfactory effect, but not in patients with liver and kidney toxicity.Research methods1, The design of experiment: by randomized controlled trial design, born of different doses of rhubarb on gastrointestinal tumor patients’ clinical treatment effect of recovery of gastrointestinal function, the change of the postoperative inflammatory reaction and immune function and postoperative complications were evaluated. Press the number will reach the requirements of the 150 patients randomly divided into five groups. Raw rhubarb dose was divided into four groups, 1 group, 2 treatment group, the 3 groups and 4 treatment group and a control group. Deadline for 2 days. Each treatment group 30 people.2, General information: March 2012 to June 2014, the 101 th hospital of the Chinese people’s liberation army general line of gastric cancer radical surgery to remove a total of 150 cases of hospitalized patients with. Into a set of standard:(1) the age of 35 to 85 years.(2) diagnosis of gastrointestinal tumors by preoperative endoscopy, colonoscopy and whole abdominal CT.(3) line open gastric cancer radical surgery(palliative surgery, D1, D2), resection of gastrointestinal stromal tumor, resection of colorectal cancer..(4) preoperative C- reactive protein(CRP) in the normal range.(5) signed informed consent. Exclusion criteria: gastrointestinal tumor complicated with severe heart, lung disease, severe liver and kidney function abnormal(2 times higher than normal), severe diabetes(2 times higher than normal amount of fasting glucose), postoperative anastomotic leakage, stump fistula.3, Treatment methods: literature, raw rhubarb in maximum dose(76 g/kg) in mice single lavage, no obvious toxic reaction was observed, but the doses for 14 consecutive d can be observed in different degree of liver and kidney damage. Human studies used daily doses of up to 3 g/(kg/d), also did not produce obvious toxic effect. So each group of patients based on the principles of gastrointestinal tumor postoperative routine treatment for fasting, gastrointestinal decompression, anti-infection, acid suppression, enteral nutrition support therapy, etc. Treatment on the basis of the above treatment 1 group, 2 group, 3 treatment group, treatment group was given 4 raw rhubarb(Jiang Yin tian-jiang pharmaceutical Jiang Su province; 1 g for each bag, the equivalent of decoction pieces(3 g), 1 group of dose of 0.3 g/(kg?d), two group dose of 0.6 g/(kg?d), 3 group dose of 0.9 g/(kg?d), four group of dose of 1.2 g/(kg?d), control group drip into the same dose of warm boiled water. Implementation plan: move each dose of rhubarb, dissolved in 300 ml warm water to anesthesia end time as a starting point, After 6 h after began to drip, drip for the first time that day half the total dose, drip again after 12 hours, the remaining half speed of 50 ml/h, after the drip, clip nasogastric tube 1 h. Deadline to 2 days. If patients in the process of the anus exhaust, stop using the raw rhubarb, if the anus exhaust, not the full dose. The control group drip off four warm boiled water.4, Observation indexes: 1) the clinical indicators: bowel sounds(2 h/time, postoperative continuous auscultation 5 min/times), for the first time the intestinal exhaust time; Postoperative gastric perfusion after patients have nausea and vomiting, abdominal distension, abdominal pain and discomfort; The postoperative complications. Postoperative hospital stay, cost index, etc. 2) detection indicators:(1) inflammatory reaction index: preoperative 1 day, postoperative days 1, 3, collection and determination of fasting serum CRP, IL- 6. Immune suspension project inspection method is used to determine c-reactive protein(CRP); Using enzyme-linked immunosorbent assay(ELISA) method for determination of interleukin 6(IL- 6) level(Bio souree company kit);(2) the cellular immune function index: preoperative 1 day, postoperative days 1,3, collection and fasting serum determination of CD3, CD4, CD8 and CD4 / CD8 ratio, using flow cytometry instrument were measured.Results1, Curative effect: the experimental group(group 1-4) bowel sound recovery time, anus exhaust time, defecation time, postoperative hospitalization time and hospitalization expenses were significantly better than that of control group(group 5), group 3、4 is better than that of 1, 2.2, The postoperative complications: experimental group(group 1-4) and the observation group(group 5) postoperative abdominal distention, nausea, vomiting, anastomotic fistula(bleeding), abdominal cavity infection, infection of incision, the comparison of difference, and postoperative diarrhea, test group compared with the other four groups, group 4 diarrhea is increased significantly.3, Inflammatory index changes: groups of patients after the operation of CRP, IL- 6 values compared with preoperative were significantly elevated, CRP after using raw rhubarb group, IL- 6 value was reduced obviously, group 3、4 is better than that of group 1, 2.4, Immune index changes: groups of patients after the operation, the first day of CD3 +, CD4 +, CD4 + / CD8 + ratio compared with preoperative reduced, the numerical 3 days after each test group showed a trend of recovery, compared the experiment group 3, 4,with group 5, that pilots were significantly higher.Conclusion1, raw rhubarb can promote gastrointestinal tumor patients postoperative gastrointestinal functional recovery, still can reduce inflammatory reaction and enhance the immune function.2, raw rhubarb dose of 0.9g/(kg?d), good curative effect, high safety, can reach the best concentration-response relationship. |
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