微米大黄炭白芨胶对上消化道内镜黏膜下剥离术后创面愈合的作用机制研究

Clinical observation and mechanism of micron rhubarb charcoal Bletilla gum in improving wound healing quality after upper gastrointestinal mucosal dissection

摘要:

目的 探究微米大黄炭白芨胶在上消化道内镜黏膜下剥离术后创面愈合中的应用效果及可能机制。方法 回顾性分析武汉市第一医院2019年10月—2021年10月收治的102例行上消化道内镜黏膜下剥离术患者的病历资料。根据治疗方案将其分为对照组和研究组，每组51例。对照组在上消化道内镜黏膜下剥离术后给予去甲肾上腺素联合埃索美拉唑治疗，研究组给予微米大黄炭白芨联合埃索美拉唑治疗。比较两组术前、术后凝血酶原时间（PT）、部分活化凝血酶原时间（APTT）、胃液及溃疡边缘黏膜中表皮生长因子（EGF）和血管内皮生长因子（VEGF）表达、溃疡愈合效果及安全性。结果 两组术后出血发生率比较，差异无统计学意义（P <0.05）。研究组术前、术后1周PT、APTT差值均低于对照组（P <0.05）。研究组术后4周与术后即刻溃疡指数差值高于对照组（P <0.05）。研究组术前、术后4周胃液中EGF、VEGF差值高于对照组（P <0.05）。两组术后4周溃疡边缘黏膜中EGF、VEGF阳性表达率均高于术前（P <0.05），研究组高于对照组（P <0.05）。两组不良反应发生率比较，差异无统计学意义（P >0.05）。结论 微米大黄炭白芨胶应用于上消化道内镜黏膜下剥离术后有助于促进创面愈合，可能与提高EGF、VEGF表达促进胃黏膜屏障重建有关。

Abstract:

Objective To explore the application effect and possible mechanism of micron rhubarb charcoal Bletilla glue in wound healing after upper gastrointestinal mucosal dissection.Methods The medical records of 102 patients with upper gastrointestinal mucosal dissection treated in our hospital from October 2019 to October 2021 were retrospectively analyzed. According to the treatment plan, they were divided into control group and study group, with 51 cases in each group. The control group was treated with norepinephrine combined with esomeprazole after upper gastrointestinal mucosal dissection, and the study group was treated with micron rhubarb charcoal Bletilla and esomeprazole. After 4 weeks of treatment, prothrombin time (PT), partially activated prothrombin time (APTT), expression of epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF) in gastric juice and ulcer marginal mucosa, ulcer healing effect, and safety were compared between the two groups.Results There was no significant difference in the incidence of postoperative bleeding between the two groups (P > 0.05). The differences of PT and APTT in the study group before and after treatment were lower than those in the control group (P < 0.05). The difference of ulcer index between 4 weeks after operation and immediately after operation in the study group was higher than that in the control group (P < 0.05). The difference levels of EGF and VEGF in gastric juice of the study group before and after treatment were higher than those of the control group (P < 0.05). The positive expression rates of EGF and VEGF in the two groups after treatment were higher than those before treatment, and that in the study group was higher than that in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05).Conclusion The application of micron rhubarb charcoal Bletilla striata after upper gastrointestinal mucosal dissection can promote wound healing, accelerate platelet aggregation, and hemostasis, which may be related to increasing the expression of EGF and VEGF to promote the reconstruction of gastric mucosal barrier.