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The effects of selected decontamination of the digestive tract on endotoxemia and inflammation mediator of patients undergoing cardiopulmonary bypass
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- Author:
- No author available
- Journal Title:
- JOURNAL OF CHINESE PHYSICIAN
- Issue:
- 2
- DOI:
- 10.3760/cma.j.issn.1008-1372.2006.02.004
- Key Word:
- 抗菌药/治疗应用;内毒素血症/预防和控制;风湿性心脏病/外科学;灌肠/方法;体外循环;心脏瓣膜假体植入
Abstract： 目的探讨选择性消化道去污染(SDD)对体外循环(CPB)心内直视术风湿性心脏病瓣膜置换术病人肠源性内毒素血症、炎症介质和临床结果的影响.方法选择风湿性心脏病瓣膜置换术CPB病人30例,随机分为对照组和SDD组各15例.对照组行常规术前肠道准备,即饮食准备和清洁灌肠;SDD组在常规准备的基础上进行术前选择性消化道去污染干预.检测2组病人在诱导麻醉、CPB结束、CPB后2 h、24 h共4个时相点循环D-乳酸、内毒素、TNF-α、补体C3值、临床生化指标,和ICU停留时间、住院时间、术后机械通气时间、抗生素使用天数等临床结果.结果(1)SDD组病人循环D-乳酸水平在诱导麻醉和CPB后2 h显著低于对照组(P＜0.05).(2)2组病人CPB后体内内毒素水平皆显著增高(P＜0.05),而SDD组在CPB结束(P＜0.01)及CPB后24 h(P＜0.05)的内毒素水平皆显著低于对照组.(3)2组病人TNF-α、补体C3水平差异无统计学意义(P＞0.05),临床生化指标及结果差异无统计学意义(P＞0.05).结论CPB心内直视术引发内毒素血症,而SDD干预是预防内毒素血症的有效肠道准备方法,但可能对炎症介质激活及临床结果无显著影响.
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