Objective To investigate the effects of rhubarb combined with glutamine on repair of gut mucosal barrier injury after gastrointestinal surgery in rats. Methods Fifty male healthy Sprague-Dawley(SD)rats were randomly divided into five groups:control(C group),enteral nutrition(EN group),rhubarb with EN(R-EN group), glutamine with EN(G-EN group)and rhubarb combined with glutamine and EN(R-G-EN group)groups(each n=10). The rats of C group received no treatment and were fed normally. Cecectomy and gastrostomy were performed in EN,R-EN,G-EN and R-G-EN groups,and in 24 hours after surgery,they were interfered with the use of amoxicillin 50 mg/d and metronidazole 20 mg twice a day. From the first day after operation,each group was treated with the same prescription of enteral isocaloric and isonitrogenous nutrition for consecutive 7 days. Seven days later, under anaesthesia,laparotomy was performed,and a specimen of 1 cm intestinal segment was taken from the terminal 5 cm long ileum for all the groups;under the light microscope,the morphological examination of intestinal mucosal epithelial tight junctions(including villus height and mucosal thickness)was carried out. For each group,enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of plasma citruline and D-lactate,and the serum concentration of TNF-αwas detected by utilizing double antibody ABC-ELISA. Results The levels of D-lactate and TNF-αin EN,R-EN,G-EN and R-G-EN groups were obviously higher than those in C group(all P<0.01). The level of plasma citruline(μmol/L:16.13±0.58 vs. 14.52±0.28)of R-G-EN group was remarkably higher than that in R-EN group(P<0.05),and its levels of serum D-lactate(mmol/L:3.12±0.56 vs. 3.62±0.52)and TNF-α(ng/L:2.82±0.62 vs. 3.54±0.49)were markedly lower than those of G-EN group(both P<0.05). The mucosal villus height(μm:126.50±6.31 vs. 175.67±11.91),mucosal thickness(μm:223.67±11.94 vs. 277.00±14.06)and the level of plasma citruline(μmol/L:13.25±0.36 vs. 15.67±0.55)in EN group were obviously lower than those of C group(all P<0.01);the above indexes of R-EN,G-EN and R-G-EN groups were higher than those of EN group (P<0.05 or P<0.01),but in the comparisons of the villus height and mucosal thickness among the three groups there were no statistical significant differences(all P>0.05). Conclusion The application of rhubarb combined with glutamine can protect gut mucosa,reduce the level of inflammatory reaction and elevate the level of plasma citruline, that is beneficial to the repair of gut mucosal barrier injury and its functional recovery after gastrointestinal surgery in rats.

Objective:To compare the operation time,peroperative and long-term postoperative complications of percutaneous tracheotomy with or without the guidance by fiberoptic broncho-scopy in intensive care unit(ICU).Methods:The clinical data of 73 patients who were performed percutaneous tracheotomy in ICU of Changshu First People's Hospital from Nov 2010 to Jan 2014 were retrospectively analyzed.Forty-three patients who accepted percutaneous tracheotomy guided by fiberoptic bronchos-copy were assigned to Group A,while the other 30 patients were assigned to Group B.The status of intraoperative and short-term and long-term postoperative complications were compared between the two groups.Results:The operation time had no significant difference between the two groups(P >0.05).Four cases(9.3%)in Group A got perioperative complications,inclu-ding 1 case of postoperative bleeding >48 h,1 case of wound infection and 2 cases of subcutaneous emphysema.Fifteen cases (50%)in Group B got perioperative complications,including 1 case of wound infection,1 case of pneumothorax,3 cases of postoperative bleeding >48 h,5 cases of subcutaneous emphysema,and 5 cases of tracheal damage on posterior wall or side wall.The differences in rate of complications between the two groups were statistically significant(P <0.05).Among the 73 patients,33 cases had be followed up,2 cases from the 18 cases who had be followed up in Group A had complications,inclu-ding 1 case of hoarseness,1 case of foreign body sensation in the throat.Two cases from the 15 cases who had be followed up in Group B had complications,including 1 case of hoarseness,1 case of dysphagia.The long-term complications rates had no significant difference between the two groups(P > 0.05).Conclusions:The percutaneous tracheotomy guided by fiberoptic bronchoscopy does not increase operation time,but can reduce the incidence of perioperative complications.