You Position: Home > Paper
Clinical study on bacterial translocation and gut barrier dysfunction in postoperative patients
( views:239, downloads:80 )
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF EMERGENCY MEDICINE
- Issue:
- 10
- DOI:
- 10.3760/j.issn:1671-0282.2004.10.005
- Key Word:
- 腹部手术;肠道细菌移位;聚合酶链反应;D-乳酸;内毒素
Abstract： 目的应用聚合酶链反应(PCR)方法及血浆D-乳酸检测,来探讨腹部外科手术后肠黏膜屏障损伤与肠道细菌移位(BT)及BT与感染并发症之间的联系.方法 63例择期腹部外科手术患者,术前和术后2、24、48 h采集外周血,进行全血细菌DNA检测、血D-乳酸、内毒素(LPS)浓度检测及血细菌培养.患者观察30 d以监测感染并发症.结果术前PCR均为阴性,术后PCR阳性12例.术后出现全身炎症反应综合征(SIRS)的患者PCR阳性率为41.7%(10／24),明显高于无SIRS组的5.1%(2／39)(P＜0.01).PCR阳性组SIRS发生率为83.3%(10／12),阴性组为27.5%(14／51),差异有显著性意义(P＜0.01).PCR阳性者66.67%(8／12)发生感染并发症,阴性者无一发生(P＜0.01).术后血细菌培养阳性率4.8%(3／63),显著低于PCR的19.0%(12／63)(P＜0.01)；血细菌培养阳性者,PCR均呈阳性.PCR阳性结果中大肠杆菌DNA阳性率占66.7%.PCR阳性的患者外周血浆D-乳酸及LPS浓度较PCR阴性者明显升高(P＜0.01),二者呈显著正相关(r=0.91,P＜0.01).结论 腹部外科术后肠黏膜屏障损伤与BT关系密切,术后早期(2h)即可发生BT,以大肠杆菌为主.术后SIRS和感染并发症与BT密切相关.
- [1]姚咏明,盛志勇,吴叶.大鼠急性肠缺血后血浆D-乳酸的变化及其与肠粘膜损害的关系[J].1998,(4).
- [2]郑常杰,贾长库,时岩.失血性休克促进细菌移位的发生[J].2000,(3).
- [3]于勇,盛志勇,柴家科,等.烧伤患者血浆D-乳酸水平和肠道内IgA含量的变化[J].2003,(2).
- [4]C JO’,Boyle,JMacFie,etc.Microbiology of bacterial translocation in humans[J].1998,42(1).
- [5]McMahon MJ,Hawkey P,Fitzgerald P,etc.The early increase in intestinal permeability and systemic endotoxin exposure in patients with severe acute pancreatitis is not associated with systemic bacterial translocation: molecular investigation of microbial DNA in the blood.[J].2003,26(1).