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Clinical study on bacterial translocation in severe multiple trauma patients
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- Author:
- No author available
- Journal Title:
- CHINESE CRITICAL CARE MEDICINE
- Issue:
- 1
- DOI:
- 10.3760/j.issn:1003-0603.2006.01.004
- Key Word:
- 多发伤;肠道细菌移位;聚合酶链反应;脓毒症
Abstract： 目的研究严重多发伤患者伤后肠道细菌移位发生情况及其与感染并发症和脓毒症的关系.方法选择外科重症监护治疗病房(SICU)收治的严重多发伤患者16例[创伤严重度评分(ISS)>20分],分别于伤后2、24和48 h采集外周血,利用聚合酶链反应(PCR)技术检测全血中细菌DNA,进行血细菌培养,检测血浆D乳酸及脂多糖(LPS)水平.所有患者均观察30 d以监测感染并发症.检测63例择期手术患者术前血D乳酸和LPS水平作为对照.结果严重多发伤后2 h即可从血中检测出细菌DNA,共有10例患者细菌DNA检测PCR阳性(62.50%).PCR阳性者脓毒症发病率为100.00%,PCR阴性者为0,差异有显著性(P<0.01).脓毒症患者PCR阳性率为100.00%,无脓毒症患者PCR阳性率为0,差异有显著性(P<0.01).脓毒症患者中70.00%发现有明确部位的感染并发症,无脓毒症患者为0,差异有显著性(P<0.05).发现感染灶的患者全部PCR阳性.血细菌培养阳性率18.75%,显著低于PCR阳性率(62.50%,P<0.01).所有PCR阳性结果中大肠杆菌DNA阳性率占70.00%(7/10例).所有患者血浆D-乳酸及LPS含量均明显升高,且二者呈显著正相关(r=0.94,P<0.01).结论严重多发伤后早期(伤后2 h)即可发生肠道细菌移位,以大肠杆菌为主.PCR方法检测血中细菌DNA能准确反映肠道细菌移位并预告感染和脓毒症的发生.
- [1]万林骏,杨家驹,黄青青,等.急性坏死性胰腺炎大鼠早期肠内营养的实验研究[J].2002,(4).
- [2]张诚,盛志勇,胡森,等.烫伤延迟复苏后肠上皮细胞凋亡诱导肠道内毒素和细菌移位[J].2003,(3).
- [3]孙晓庆,付小兵,张蓉,等.创伤后肠道通透性改变血浆标志物D乳酸的实验研究[J].2000,(8).
- [4]王忠堂,姚咏明,肖光夏,等.双歧杆菌对烫伤大鼠肠道黏膜机械及生物屏障的改善作用[J].2003,(3).
- [5]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).
- [6]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).
- [7]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).
- [8]王军民,张正,文黎明.蛙皮素抑制失血-感染大鼠肠道细菌移位的实验研究[J].2002,(8).
- [9]姚咏明,田惠民,王亚平,等.过氯酸新法预处理血浆定量检测微量内毒素的鲎试验方法及其应用[J].1993,(1).
- [10]D N, Herndon,S T, Zeigler.Bacterial translocation after thermal injury.[J].1993,21(2 Suppl).
- [11]T D, Kane,S R, Johnson,J W, Alexander,etc.Detection of intestinal bacterial translocation using PCR.[J].1996,63(1).
- [12]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).
- [13]王达利,王玉明,程代薇,等.烧伤病人早期肠源性感染临床研究[J].2000,(2).
- [14]王亚平,付小兵,孙同柱.碱性成纤维细胞生长因子对肠缺血大鼠细菌易位的影响[J].1996,(12).
- [15]吴承堂,黎沾良,熊德鑫.质粒载体示踪法用于急性坏死性胰腺炎肠道细菌易位的研究[J].1998,(8).
- [16]Michael J. Murray,Mark D. Gonze,Lisa R. Nowak,etc.Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia[J].1994,167(6).
- [17]次秀丽,王宝恩,张淑文,等.肿瘤坏死因子和内毒素致大鼠肠粘膜屏障损伤的中药治疗研究[J].1999,(5).
- [18]C JO’,Boyle,JMacFie,etc.Microbiology of bacterial translocation in humans[J].1998,42(1).
- [19]T D, Kane,J W, Alexander,J A, Johannigman.The detection of microbial DNA in the blood: a sensitive method for diagnosing bacteremia and/or bacterial translocation in surgical patients.[J].1998,227.
- [20]Taura P,Lacy A,Garcia-Valdecasas JC,etc.Bacterial translocation of enteric organisms in patients with cirrhosis.[J].2001,34(1).