RESUMO
Objective 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.