大黄及不同营养途径对侵袭性真菌感染的影响机制研究

目的研究大黄及不同营养途径对侵袭性真菌感染的防治作用。方法将1 090例严重创伤、休克、感染等并发脓毒症的患者随机分为大黄预防组(637例)和非大黄预防组(453例);两组再分肠内营养、肠内外营养、肠外营养和无营养支持4个亚组。观察各组真菌感染的发生率。结果大黄预防组真菌感染发生率为3.0%;而非大黄预防组发生率为11.5%,两组间比较差异有显著性(P<0.05)。大黄预防组中肠内营养337例,并发真菌感染3例(占0.9%);而非大黄预防组中肠内营养178例,并发真菌感染7例(占3.9%),两组间比较差异有显著性(P<0.05)。大黄预防组中肠内外营养179例,并发真菌感染2例(占1.1%);而非大黄预防组中肠内外营养127例,并发真菌感染9例(占7.1%),两组间比较差异有显著性(P<0.01)。肠外营养和无营养支持的两组患者真菌感染的发生率差异也有显著性(P<0.05或P<0.01);肠外营养组真菌感染发生率高于肠内营养和肠内外营养组(P均<0.05);无营养支持患者的真菌感染发生率最高(30.4%和61.3%)。结论大黄及肠内营养通过胃肠道机制对侵袭性真菌感染有一定的防治作用。

Effects of rhubarb (大黄) and different routes of nutrition support on invasive fungal infection

OBJECTIVE: To study the effects of rhubarb and the different routes of nutrition support on invasive fungal infection. METHODS: One thousand and ninety patients, who suffered from sepsis subsequent to trauma, shock and infection were enrolled in this study. The patients were randomly divided into two groups, 637 cases in rhubarb preventive treatment group and 453 cases in non-preventive rhubarb treatment group. They were again divided into four subgroups: enterenteral nutrition support, and no nutrition support group. The incidence of invasive fungal infection was observed in those groups. RESULTS: The incidence of invasive fungal infection in rhubarb preventive treatment group (3.0%) was much lower than that in non-preventive rhubarb treatment group (11.5%). There was significant difference between two groups (P<0.05). Furthermore, fewer patients developed invasive fungal infection in enteral nutrition support and enteral combined parenteral nutrition support subgroups after preventive rhubarb treatment (0.9% and 2.1%), compared with parenteral nutrition support and no nutrition support subgroups (30.4% and 61.3%) and corresponding subgroups with non-preventive treatment of rhubarb (3.9% and 7.1%, P<0.05 or P<0.01). In addition, the route of nutrition support also affected the incidence of invasive fungal infection. Patients in enteral nutrition support and enteral combined parenteral nutrition support subgroups had lower incidence of invasive fungal infection than in parenteral nutrition support and no nutrition support subgroups (all P<0.05), and the incidence was the highest in no nutrition support subgroup. There were no significant difference between parenteral nutrition support and no nutrition support subgroups. CONCLUSION: Rhubarb and enteral nutrition support have preventive effects on invasive fungal infection via gut mechanism.