Kev Tshawb Fawb Kev Txhim Kho ntawm Lactulose hauv Kev Npaj plab hnyuv hauv cov neeg mob nrog cem quav Ⅰ

【Cov Lus Qhia】 Colonoscopy yog ib qho tseem ceeb ntawm kev kuaj cov kab mob hauv plab, tab sis qee qhov kev tshawb fawb tau pom tias cem quav yuav cuam tshuam rau kev npaj plab hnyuv zoo, thiab kev npaj plab tsis txaus yuav txo qhov kev kuaj pom ntawm cov kab mob microscopic. Lactulose tau ua tiav cov txiaj ntsig zoo li osmotic laxative hauv kev kho cem quav. Nyob rau hauv xyoo tas los no, ntau thiab ntau cov kev saib xyuas tau them rau kev ntxuav cov hnyuv hauv cov neeg mob cem quav. Nyob rau hauv daim ntawv no, los ntawm retrieving domestic thiab txawv teb chaws cov ntaub ntawv, daim ntawv no ua ib daim ntawv qhia txog kev kho mob ntawm cem quav los ntawm lactulose nyob rau hauv ntau haiv neeg, cov xwm txheej ntawm polyethylene glycol nyob rau hauv lub plab npaj, thiab kev tshawb fawb raws li txoj cai ntawm lactulose ua ke nrog polyethylene glycol hauv kev npaj plab hnyuv. nyob rau hauv cov neeg mob nrog cem quav. tshuaj xyuas.

Nyem rau tam sim cem quav cov neeg laus

【Cov lus tseem ceeb】 Lactulose; Polyethylene glycol; cem quav; Kev npaj plab hnyuv; Colonoscopy

Kev kuaj pom polyp feem ntau yog nyob ntawm kev npaj plab hnyuv, thiab kev tshawb fawb tau pom tias kev npaj plab hnyuv tau txiav txim siab txaus yog tias pom tau tias polyps > 5 mm tuaj yeem kuaj pom [1-2]. Kev cem quav ntev yog ib qho kev pheej hmoo ntawm kev tsis txaus siab rau kev npaj plab hnyuv, uas yuav txo qis qhov ua tiav thiab qhov tseeb ntawm txoj hnyuv loj thiab txo qis kev nyab xeeb ntawm kev kho mob endoscopic [3].

Raws li cov ntaub ntawv tam sim no, qhov tshwm sim ntawm cem quav nyob rau hauv cov neeg laus thoob ntiaj teb yog 0.7% mus rau 79% ( nruab nrab 16%) [4]. Feem ntau ntawm cem quav nyob rau hauv cov pej xeem ntawm cov neeg laus nyob rau hauv kuv lub teb chaws yog 3. 19% rau 17. 6% [5-7]. Kev cem quav tsis zoo cuam tshuam rau lub neej zoo thiab lub cev thiab lub hlwb kev noj qab haus huv ntawm cov neeg mob [8], 12% txog 19% ntawm cov neeg Asmeskas muaj teeb meem loj, thiab tag nrho cov nqi ncaj qha txhua xyoo ntawm txhua tus neeg mob nrog cem quav ntev yog kwv yees li ntawm MYM1912. thiab MYM7522, nkim ntau cov khoom tsim tau thiab kev kho mob, ua rau muaj kev lag luam hnyav [9].

Cov lus qhia hauv tsev [10] pom zoo tias rau cov neeg mob cem quav ntev, ua ntej noj cov tshuaj laxative lossis ua ke siv cov tshuaj ua rau lub plab zom mov tuaj yeem txhim kho cov nyhuv ntxuav. Kab lus no tshuaj xyuas kev tshawb fawb txog kev nce qib ntawm lactulose hauv cov neeg mob cem quav.

01 Mechanism ntawm lactulose plab hnyuv ntxuav

Lactulose yog "disaccharide" uas muaj galactose thiab fructose, tsim los ntawm isomerization ntawm lactose. Nws yog prebiotic carbohydrate. Lactulose tsis yog hydrolyzed nyob rau hauv cov hnyuv me thiab decomposed rau hauv cov suab thaj yooj yim los ntawm cov kab mob ib txwm tom qab nkag mus rau hauv txoj hnyuv. Nws txhawb kev loj hlob ntawm cov kab mob uas muaj txiaj ntsig zoo xws li bifidobacteria thiab lactic acid kab mob hauv txoj hnyuv, thiab tib lub sijhawm inhibits cov kab mob pathogenic xws li salmonella. Kev loj hlob ntawm cov kab mob. Nws yog ntxiv decomposed rau hauv cov organic acids xws li lactic acid thiab acetic acid, txo tus nqi pH ntawm txoj hnyuv yog qhov tsim nyog rau kev tsim thiab kev loj hlob ntawm cov hnyuv ib txwm muaj, thiab tswj cov qauv ntawm cov hnyuv. Cov plab hnyuv pH qis tuaj yeem txhawb cov plab hnyuv peristalsis, ua kom lub sijhawm hloov ntawm txoj hnyuv, thiab txhawb nqa qhov quav. Lactulose tseem muaj cov haujlwm osmotic ntawm disaccharides, khaws cov dej thiab cov electrolytes hauv plab hnyuv kom tsim cov nyhuv hyperosmotic, ua kom cov quav ntim, softens cov quav, thiab ua tiav lub hom phiaj ntawm laxatives [11-12].

02 Kev kho Lactulose ntawm kev tshawb nrhiav cem quav

Raws li Rome Ⅳ tus qauv [13], kev cem quav ntev yog muab faib ua kev ua haujlwm cem quav thiab cem quav. Raws li kev sib txawv ntawm cov txheej txheem pathophysiological ntawm kev ua haujlwm cem quav, nws tuaj yeem muab faib ua ntu ntu ntu ntuav, ntuav ntuav ntuav, ntuav cem quav, thiab cem quav. Rau kev kho mob cem quav, tus kws tshaj lij pom zoo [14] ntseeg tias kev noj zaub mov thiab kev ua neej yuav tsum tau hloov ua ntej, xws li kev noj zaub mov kom tsawg, nce dej kom tsawg, thiab ua kom muaj zog; Thib ob, kev kho tshuaj, xws li siv lactulose los yog polyethylene glycol (polyethylene glycol) Glycol, PEG) thiab lwm yam osmotic laxatives, yog tias cov tsos mob tseem tsis zoo, nws raug nquahu kom noj cov tshuaj stimulant xws li senna rau cov neeg mob tsis teb.

Nyob rau hauv ib tug Japanese randomized tsis ntev los no, ob-dig muag txoj kev tshawb no [15], kev nyab xeeb thiab kev ua tau zoo ntawm ntau npaum li cas ntawm lactulose nyob rau hauv kev kho mob ntawm constipation. Hauv txoj kev tshawb no, cov kev kawm tau muab faib ua 4 pawg, xws li lactulose 13 g / d pawg, 26 g / d pawg, 39 g / d pawg, thiab pab pawg placebo, lub sijhawm kho tau ntev li 2 lub lis piam, thiab thawj qhov kawg ntawm cov tshuaj. Kev soj ntsuam qhov ntsuas yog qhov zaus ntawm kev tso quav tawm ntawm tus kheej los ntawm lub hauv paus hauv thawj lub lim tiam.

Cov txiaj ntsig tau pom tias qhov zaus ntawm cov quav tso quav hauv 26 g / d pawg thiab 39 g / d pawg tau txhim kho zoo dua piv nrog cov placebo pawg, uas yog 3. 77 zaug / lub lis piam, 5. 05 zaug /lub lim tiam, 2. 05 zaug / lub lis piam, thiab qhov kev nce no yog nyob ntawm koob tshuaj ntawm 26 g / d pawg thiab 39 g / d pawg. Cov kev phiv tshwm sim feem ntau yog ua rau plab zom mov, xws li raws plab, mob plab, mob plab, thiab lub suab tsis zoo ntawm plab hnyuv. Tus naj npawb thiab qhov tshwm sim ntawm qhov tshwm sim tsis zoo hauv txhua pab pawg yog 2 tus neeg mob (3.2%), 4 tus neeg mob (6.3%), 13 tus neeg mob (21.0%), thiab 6 tus neeg mob (9.7%). Hauv 39 g / d pawg, 13 tus neeg mob (21.0%) tau cuam tshuam nrog cov tshuaj tsis zoo uas tau hais los saum no, tshwj xeeb tshaj yog raws plab hauv 6 tus neeg mob (9.7%). Yog li, qhov kev tshawb fawb no ntseeg tias kev tswj qhov ncauj ntawm 26 g / d yog qhov koob tshuaj zoo tshaj plaws rau kev kho mob cem quav.

2. 1 Kev tshawb fawb txog cov txiaj ntsig ntawm lactulose rau cem quav ntev hauv cov menyuam mos thiab menyuam yaus

Lactulose yog tam sim no ib qho ntawm feem ntau siv osmotic laxatives rau cov me nyuam cem quav, thiab raws li cov ntaub ntawv pov thawj, Dutch cov lus qhia pom zoo lactulose raws li kev xaiv thawj zaug rau cov menyuam yaus hnub nyoog qis dua 1 xyoos. Rau cov menyuam yaus hnub nyoog qis dua 1 xyoos, xws li lactulose lossis PEG nrog lossis tsis muaj electrolytes ntxiv tuaj yeem yog thawj txoj kev kho mob. Ib txoj kev tshawb fawb [16] tshawb nrhiav kev ua tau zoo thiab kev nyab xeeb ntawm lactulose hauv kev kho mob cem quav hauv Suav cov menyuam yaus. Hauv txoj kev tshawb no, 100 cov menyuam yaus hnub nyoog 2 txog 6 xyoo tau muab faib ua pawg kho mob thiab pab pawg placebo. Cov neeg mob hauv pab pawg kho mob tau noj 5 mL ib hnub ntawm Lactulose (3. 3 g) rau 6 lub lis piam. Cov ncauj lus hauv pab pawg placebo kuj tau txais kev kho cov placebo rau tag nrho 6 lub lis piam. Tom qab 6 lub lis piam ntawm kev kho mob, cov quav txhua hnub thiab cov quav tsis sib xws hauv pawg kho mob tau zoo dua qub piv nrog cov neeg hauv pawg tswj hwm (ob leeg P ＜ 0.01). Tsis muaj kev phiv loj heev tau pom nyob rau hauv pab pawg lactulose, thiab kev nyab xeeb ntawm ob pawg zoo sib xws, uas yog raws li kev tshawb fawb ntawm Lei Yanwei li al. [17].

2. 2. Kev tshawb fawb txog kev cuam tshuam ntawm lactulose rau cem quav ntev hauv cov neeg laus

Tag nrho qhov muaj feem ntau ntawm cem quav nyob rau hauv cov poj niam yog yuav luag ob npaug ntawm cov txiv neej, thiab qhov muaj feem ntau nce nrog hnub nyoog [18-19]. Qhov tshwm sim ntawm cem quav ntev yog kwv yees li 16% hauv cov neeg laus thiab tuaj yeem ncav cuag 33% hauv cov neeg laus dua 60 xyoo [20].

Ib qho kev soj ntsuam meta hauv kuv lub teb chaws [21] suav nrog 5 qhov kev tshawb fawb tswj kev sib luag, tag nrho ntawm 682 tus neeg mob, 392 txiv neej thiab 290 tus poj niam, hnub nyoog 60-93 xyoo, piv rau kev kho mob tus nqi thiab tag nrho cov txiaj ntsig zoo ntawm pawg lactulose thiab pawg tswj hwm. efficiency. Cov txiaj ntsig ntawm Meta-analysis pom tias yog tias cov neeg mob laus tau kho nrog lactulose piv nrog cov pab pawg tswj, qhov cim thiab tag nrho cov txiaj ntsig tau zoo tau nce ntxiv [OR yog 2. 95 (95% CI 1. 32 ~ 6. 59). ) thiab 5. 76 (95% CI 3. 50-9. 45)], Lactulose Oral Liquid muaj cov nyhuv curative tseeb hauv kev kho mob cem quav, tsis muaj kab mob plab, thiab muaj kev phiv tsis zoo, tshwj xeeb tshaj yog haum rau cov neeg laus. Wang Peng et al. [22] kuj tau qhia tias lactulose tuaj yeem ua rau muaj qhov ntau ntawm kev tso quav hauv cov neeg laus, thiab nws tsis yooj yim ua rau cov quav deformed.

2. 3. Kev tshawb fawb txog kev cuam tshuam ntawm lactulose ntawm cem quav ntev hauv cov poj niam cev xeeb tub thiab tom qab yug me nyuam

Kev tshawb fawb ntau qhov chaw, randomized, ob-dig muag, kev soj ntsuam cov placebo-tswj [23] pom tag nrho ntawm 63 tus poj niam cev xeeb tub nrog cem quav. Hauv lub lim tiam dhau los ntawm kev kho mob, qhov nruab nrab cov quav quav ntawm pab pawg lactulose tau txhim kho zoo, thiab cov txiaj ntsig zoo ntawm pawg lactulose tau txhim kho zoo nyob rau tib lub sijhawm. Kuj siab dua cov placebo pawg (61. 3% vs 46. 9%). Thaum kawg ntawm kev kho mob, ntau cov kev kawm hauv pab pawg lactulose tau txhim kho lossis txhim kho (64.6% vs 50.5%). Cov cim tseem ceeb, kev kuaj lub cev, thiab qhov tshwm sim ntawm cev xeeb tub (qhov hnyav me nyuam mos, qhov siab, Apgar qhab nia) ntawm cov kev kawm hauv ob pawg yog qhov qub. Kev tshawb fawb hauv ntau lub chaw, cov qauv loj ntawm kev soj ntsuam kev ua tau zoo thiab kev nyab xeeb ntawm lactulose hauv kev cem quav tom qab yug me nyuam [24] tau pom tias tom qab kev cuam tshuam nrog lactulose, cov quav tsis sib xws, ntau zaus defecation txhua hnub, lub sij hawm defecation, thiab defecation nyuaj txhua tus muaj kev hloov loj. Kev txhim kho tseem ceeb, thiab tseem tswj tau qhov kev kho mob zoo tom qab tshem tawm cov tshuaj. Cov ntsuas ntshav, zis, thiab cov quav tsis zoo qhia tau tias muaj kev poob qis. Qhov no yog ua raws li kev tshawb fawb ntawm Zhang Long li al. [25]. Lactulose tuaj yeem txhim kho cem quav ntev hauv cov poj niam cev xeeb tub thiab tom qab yug menyuam.

2. 4. Kev tshawb fawb txog lactulose ntawm cem quav ntev hauv cov neeg mob ntshav qab zib

Kev cem quav yog ib qho tsos mob ntawm cov neeg mob ntshav qab zib. Rau cov neeg mob ntshav qab zib, lactulose yog ib qho zoo osmotic laxative rau kev kho cem quav. Nyob rau tib lub sijhawm, nws pab txhim kho txoj hnyuv plab tsis txaus ntawm cov neeg mob ntshav qab zib thiab tej zaum yuav muaj txiaj ntsig zoo rau lawv cov ntshav qab zib tswj [26]. Kev tshawb fawb nyob rau hauv xyoo tas los no tau pom tias ib koob tshuaj ntawm 10 g thiab 20 g ntawm crystalline los yog kua lactulose tuaj yeem ua kom cov ntshav qab zib nyob hauv cov ntsiab lus noj qab haus huv tsis hloov pauv, qhia tias cov neeg mob uas muaj cov piam thaj tsis txaus tuaj yeem siv tau zoo [27].

Ntuj Herbal Tshuaj Rau Relieving cem quav-Cistanche

Cistanche yog ib tug genus ntawm parasitic nroj tsuag uas belongs rau tsev neeg Orobanchaceae. Cov nroj tsuag no paub txog lawv cov khoom siv tshuaj thiab tau siv hauv Cov Tshuaj Suav Tshuaj (TCM) rau ntau pua xyoo. Cov hom Cistanche feem ntau pom muaj nyob hauv thaj av qhuav thiab suab puam ntawm Tuam Tshoj, Mongolia, thiab lwm qhov chaw ntawm Central Asia. Cistanche nroj tsuag yog tus cwj pwm los ntawm lawv cov nqaij tawv, yellowish stems thiab muaj nuj nqis heev rau lawv cov txiaj ntsig kev noj qab haus huv. Hauv TCM, Cistanche ntseeg tau tias muaj cov khoom siv tonic thiab feem ntau yog siv los kho lub raum, txhim kho qhov tseem ceeb, thiab txhawb kev ua haujlwm ntawm kev sib deev. Nws kuj yog siv los daws cov teeb meem ntsig txog kev laus, qaug zog, thiab kev noj qab haus huv tag nrho. Thaum Cistanche muaj keeb kwm ntev ntawm kev siv tshuaj ib txwm siv, kev tshawb fawb tshawb fawb txog nws txoj kev ua tau zoo thiab kev nyab xeeb tsis tu ncua thiab txwv. Txawm li cas los xij, nws paub tias muaj ntau yam bioactive tebchaw xws li phenylethanoid glycosides, iridoids, lignans, thiab polysaccharides, uas tuaj yeem ua rau nws cov teebmeem tshuaj.

Wecistanche covcistanche hmoov, cistanche ntsiav tshuaj, cistanche capsules,thiab lwm yam khoom tsim los sivsuab puamcistancheraws li cov khoom siv raw, txhua yam muaj txiaj ntsig zoo rau kev tshem tawm cem quav. Cov txheej txheem tshwj xeeb yog raws li hauv qab no: Cistanche ntseeg tau tias muaj cov txiaj ntsig zoo rau kev tshem tawm cem quav raws li nws cov kev siv ib txwm siv thiab qee cov tshuaj uas nws muaj. Txawm hais tias kev tshawb fawb tshawb fawb tshwj xeeb ntawm Cistanche qhov cuam tshuam rau cem quav yog txwv, nws tau xav tias muaj ntau lub tswv yim uas yuav ua rau nws muaj peev xwm txo tau cem quav. Laxative nyhuv:Cistanchetau ntev tau siv nyob rau hauv tsoos suav tshuaj raws li ib tug tshuaj rau cem quav. Nws ntseeg tau tias muaj cov nyhuv laxative me me, uas tuaj yeem pab txhawb kev zom zaub mov thiab ua rau cem quav. Cov nyhuv no tuaj yeem raug ntaus nqi rau ntau lub tebchaw nyob hauv Cistanche, xws li phenylethanoid glycosides thiab polysaccharides. Moistening cov hnyuv: Raws li kev siv ib txwm siv, Cistanche suav hais tias muaj cov khoom siv moisturizing, tshwj xeeb yog tsom rau cov hnyuv. Los ntawm kev txhawb hydration thiab lubrication ntawm cov hnyuv, nws yuav pab tau soften cov cuab yeej thiab pab kom yooj yim dua, li no relieving cem quav. Anti-inflammatory Effect: cem quav tej zaum yuav txuam nrog o nyob rau hauv lub plab zom mov. Cistanche muaj qee qhov sib txuas, suav nrog phenylethanoid glycosides thiab lignans, uas ntseeg tau tias muaj cov tshuaj tiv thaiv kab mob. Los ntawm kev txo cov kab mob hauv cov hnyuv, nws tuaj yeem pab txhim kho kev zom zaub mov tsis tu ncua thiab txo qhov cem quav.