摘要目的：比较中药大黄或甘油灌肠导泻肠道去污在全身炎症反应综合征（SIRS）患者炎症反应调节中的作用，并探讨其作用机制。方法采用前瞻性随机对照研究方法，收集2009年6月至2014年6月航空总医院普通外科确诊为SIRS的57例患者，按随机数字表法分成大黄去污组、传统去污组及空白对照组3组，每组19例。3组患者均给予抗感染、手术、止痛、营养支持和维持水、电解质平衡等治疗，在此基础上，大黄去污组使用生大黄15～20 g浸液由胃管注入、灌肠或者口服，每日2次；传统去污组使用开塞露或甘油灌肠剂纳肛或灌肠，每日2次；空白对照组不进行灌肠或胃管注入。于治疗前和治疗后72 h取血，采用酶联免疫吸附试验（ELISA）检测内毒素脂多糖（LPS）及炎性介质水平。结果空白对照组、传统去污组和大黄去污组治疗前白细胞介素（IL-1、IL-8）、LPS、血小板活化因子（PAF）、肿瘤坏死因子-α（TNF-α）、γ-干扰素（IFN-γ）水平相近〔IL-1（ng/L）：53.154±5.783、50.564±5.771、51.082±6.403，F＝0.994，P＝0.377；IL-8（ng/L）：70.492±6.146、68.376±6.112、68.673±8.384，F＝0.514，P＝0.601；LPS（μg/L）：11.630±2.449、10.858±2.307、10.463±2.145，F＝1.261，P＝0.291；PAF（μg/L）：4.173±0.395、4.051±0.362、4.078±0.487， F＝0.446，P＝0.642；TNF-α（ng/L）：132.498±10.772、129.735±12.881、127.207±11.514，F＝0.963，P＝0.388；IFN-γ（μg/L）：45.645±4.558、43.692±5.578、43.767±5.028，F＝0.904，P＝0.411〕。3组治疗后各指标均较治疗前明显下降；与空白对照组和传统去污组比较，大黄去污组治疗后LPS及炎性介质降低更为明显〔LPS（μg/L）：7.571±1.113比9.008±1.904、8.874±1.808，F＝4.416，P＝0.017；IL-1（ng/L）：45.309±3.563比48.731±4.466、46.112±4.322，F＝3.557，P＝0.035；IL-8（ng/L）：60.492±5.346比65.553±5.384、63.437±5.462，F＝4.213，P＝0.020；PAF（μg/L）：3.519±0.250比3.832±0.356、3.766±0.309，F＝5.450， P＝0.007；TNF-α（ng/L）：114.988±8.772比123.230±10.433、118.534±9.519，F＝3.525，P＝0.036；IFN-γ（μg/L）：38.683±3.190比41.831±4.122、39.161±3.972，F＝3.820，P＝0.028〕。结论肠道去污能够明显影响SIRS患者内毒素及炎性介质水平，以中药大黄的作用更佳，其机制可能与其保护肠膜屏障功能有关。

abstractsObjective To explore the effect of selective gut decontamination in regulation of inflammatory reaction compared with rhubarb and glycerine enema for catharsis in patients with systemic inflammatory response syndrome ( SIRS ), and to discuss its mechanisms. Methods A prospective randomized controlled trial was conducted. Fifty-seven patients with SIRS admitted to Department of General Surgery of Aviation General Hospital from June 2009 to June 2014 were enrolled. The patients were randomly divided into rhubarb decontaminate group, traditional decontaminate group and blank control group, with 19 cases in each group. Besides the treatment for primary disease, including anti-infection, operation, alleviate pain, nutritional support, and maintaining water and electrolyte balance, the patients in rhubarb decontaminate group received aqueous extract from rhubarb 15-20 g by gastric tube, enema, or peros, twice a day;and those in traditional decontaminate group received glycerine enema or glycerol enema, twice a day; while no gavage or enema was prescribed in blank control group. Peripheral blood was collected before and 72 hours after treatment. Enzyme linked immunosorbent assay ( ELISA ) was used to determine the concentration of lipopolysaccharide ( LPS ) and inflammatory mediators. Results Compared with blank control group and traditional decontaminate group, the levels of interleukins ( IL-1, IL-8 ), LPS, platelet activating factor ( PAF ), tumor necrosis factor-α( TNF-α), andγ-interferon ( IFN-γ) before treatment was similar to that of rhubarb decontaminate group [ IL-1 ( ng/L ): 53.154±5.783, 50.564±5.771, 51.082±6.403, F = 0.994, P = 0.377; IL-8 ( ng/L ): 70.492±6.146, 68.376±6.112, 68.673±8.384, F=0.514, P=0.601;LPS (μg/L ):11.630±2.449, 10.858±2.307, 10.463±2.145, F = 1.261, P = 0.291; PAF (μg/L ): 4.173±0.395, 4.051±0.362, 4.078±0.487, F = 0.446, P = 0.642; TNF-α( ng/L ):132.498±10.772, 129.735±12.881, 127.207±11.514, F=0.963, P=0.388;IFN-γ(μg/L ):45.645±4.558, 43.692±5.578, 43.767±5.028, F = 0.904, P = 0.411 ]. The above parameters after treatment were significantly lower than those before treatment in three groups. The effect on the LPS and pro-inflammatory factors of the rhubarb decontaminate group was more obvious than that of the blank control group and traditional decontaminate group [ LPS (μg/L ): 7.571±1.113 vs. 9.008±1.904, 8.874±1.808, F = 4.416, P = 0.017; IL-1 ( ng/L ): 45.309±3.563 vs. 48.731±4.466, 46.112±4.322, F = 3.557, P = 0.035; IL-8 ( ng/L ): 60.492±5.346 vs. 65.553±5.384, 63.437±5.462, F = 4.213, P = 0.020; PAF (μg/L ): 3.519±0.250 vs. 3.832±0.356, 3.766±0.309, F = 5.450, P = 0.007; TNF-α ( ng/L ): 114.988±8.772 vs. 123.230±10.433, 118.534±9.519, F = 3.525, P = 0.036; IFN-γ(μg/L ):38.683±3.190 vs. 41.831±4.122, 39.161±3.972, F=3.820, P=0.028 ]. Conclusion The usage of selective gut decontamination can inhibit the release of endotoxin and inflammatory mediators in patients with SIRS, and it will get a better effect using rhubarb, and the mechanism may be related to the protection of intestinal mucosal barrier function.