摘要
目的:探讨上腹部中、大手术后肠道细菌易位(BT)与术后全身炎性反应综合征(SIRS)的关系.方法:选择60例大、中型上腹部手术患者,于术前和术后1、3、5d采集外周血,进行血浆D-乳酸,全血细菌DNA检测.全血DNA提取后进行PCR扩增,采用靶基因为大肠杆菌特异性β半乳糖苷酶基因和16SrRNA基因.观察患者术后10d以监测SIRS情况.结果:术前PCR检测全血细菌DNA均为阴性,术后共有14例阳性.PCR阳性组SIRS发生率为85.7%(12/14),阴性组为21.7%(10/46),差异显著(P<0.01);术后出现SIRS的患者PCR阳性率为54.5%(12/22),无SIRS组为5.3%(2/38),差异显著(P<0.01);大手术组PCR阳性率为38.5%(10/26),中手术组PCR阳性率为11.8%(4/34),差异显著(P<0.05).PCR阳性的患者外周血血浆D-乳酸浓度较PCR阴性者明显升高(5d:11.53mg/L±0.68mg/Lvs5.70mg/L±2.46mg/L,P<0.01),有SIRS的患者外周血血浆D-乳酸浓度较无SIRS患者明显升高(5d:10.61mg/L±1.77mg/Lvs5.02mg/L±1.8mg/L,P<0.01).结论:上腹部大、中型手术后肠黏膜屏障损伤与BT关系密切,术后SIRS和与BT密切相关.PCR技术对术后SIRS有较好的早期预警价值.
AIM：To investigate the relationship between bacterial translocation and acute systemic inflammatory syndrome（SIRS） in patients who underwent moderate or major upper abdominal operations.METHODS：Sixty patients who underwent moderate or major upper abdominal operations were observed.Blood samples were collected before surgery and 1,3,5 d after surgery to detect plasma D-lactate and isolate genomic DNA.PCR analysis was performed to amplify the β-galactosidase gene of Escherichia coli and 16S rRNA gene.SIRS was monitored in all patients for 10 days.RESULTS：PCR results were negative in all the patients before operation,while positive PCR results were obtained in 14 patients after surgery.Twelve patients who showed positive PCR results had SIRS（12/14,85.7%）,while only 21.7% of patients（10/46） with negative PCR results had SIRS（P 0.01）.The positive rate of PCR test was significantly higher in patients with SIRS than in those without SIRS [54.5%（12/22） vs 5.3%（2/38）,P 0.01],and in patients undergoing major operations than in those undergoing moderate operations [38.5%（10/26） vs 11.8%（4/34）,P 0.05].Plasma level of D-lactate was signif icantly higher in patient with positive PCR results than in those with negative PCR results（5 d：11.53 mg/L ± 0.68 mg/L vs 5.70 mg/L ± 2.46 mg/L,P 0.01） and in patients with SIRS than in those without SIRS（5 d：10.61 mg/L ± 1.77 mg/L vs 5.02 mg/L ± 1.8 mg/L,P 0.01）.CONCLUSION：Increased intestinal permeability is closely related to bacterial translocation,and bacterial translocation is closely related to SIRS.
出处
《世界华人消化杂志》
CAS
北大核心
2011年第6期640-643,共4页
World Chinese Journal of Digestology
基金
黎介寿院士肠道屏障研究专项基金资助项目
No. LJS_201013~~
关键词
肠黏膜屏障功能障碍
细菌易位
D-乳酸
全身炎症反应综合征
Gut barrier dysfunction
Bacterial translocation
D-lactate
Systemic inflammatory response syndrome
