胰十二指肠切除术后肠黏膜屏障损伤及SIRS与肠道细菌移位的关系(1)
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[摘要] 目的 探讨胰十二指肠切除术后肠黏膜屏障损伤与肠道细菌移位的关系。 方法 将50例行胰十二指肠切除术患者术前及术后24 、48 、72 h检验全血细菌DNA、血浆D—乳酸和内毒素水平与空白对照组比较。 结果 术前所有患者细菌DNA PCR结果均为阴性，术后72 h内PCR检测阳性10例(20.00%)，术后SIRS 组与无SIRS组差异有统计学意义(P <0.01)。空白对照组与病例组术前血浆D—乳酸和内毒素水平差异无统计学意义(P > 0.05)，病例组术后各时段血浆D—乳酸和内毒素均显著高于术前(P < 0.05)，胰十二指肠切除术后患者血浆D—乳酸和内毒素呈正相关(P <0.05)。PCR阳性组血浆D—乳酸和内毒素显著高于PCR阴性组(P < 0.01)，SIRS组血浆D—乳酸和内毒素显著高于无SIRS组(P <0.01)。 结论 胰十二指肠切除术后肠黏膜屏障损伤、SIRS与肠道细菌移位密切相关，细菌DNA PCR有助于早期诊断肠道细菌移位。
[关键词] 胰十二指肠切除术；肠黏膜屏障；全身炎症反应综合征；细菌移位
[中图分类号] R656 [文献标识码] B [文章编号] 1673—9701(2012)27—0017—03
Relationship of pancreatoduodenectomy in postoperative intestinal mucosal barrier injury and SIRS and bacterial translocation
ZHU Xiajin
Department of General Surgery， Haining City People's Hospital in Zhejiang Province， Haining 314400， China
[Abstract] Objective To investigate the relationship of intestinal mucosal barrier injury and SIRS and bacterial translocation in patients who underwent pancreatoduodenectomy. Methods The whole blood of bacterial DNA， plasma D—lactate and endotoxin levels of preoperative and postoperative 24 h， 48 h， 72 h between 50 cases with pancreaticoduodenectomy and the blank control group were compared. Results All patients with bacterial DNA PCR results were negative within 72 h after a positive PCR test in 10 cases (20.00%)， postoperative SIRS group and the non—SIRS group difference were statistically significant (P < 0.01). The plasma D—lactate and endotoxin levels were no statistically significant differences between blank control group and cases group(P > 0.05)， the plasma D—lactate and endotoxin in the case group at various time intervals after were significantly higher than preoperative(P < 0.05)， after pancreatoduodenectomy the postoperative plasma D—lactate and endotoxin were positively correlated (P < 0.05). PCR—positive plasma D—lactate and endotoxin were significantly higher than PCR—negative group (P < 0.01)， the SIRS group plasma D—lactate and endotoxin were significantly higher than with non—SIRS group(P < 0.01). Conclusion After pancreatoduodenectomy intestinal mucosal barrier injury and SIRS， are closely related to intestinal bacterial translocation bacterial， DNA PCR will help early diagnosis of intestinal bacterial translocation.
[Key words] Pancreaticoduodenal resection； Intestinal mucosa screen； Systemic inflammatory response syndrome； Bacterial translocation
全身炎症反应综合征(systemic inflammatory response syndrome， SIRS)是导致肠道重建术后常见并发症，进一步可能发展为多器官功能障碍综合征，是患者死亡的主要原因[1]。胃肠道术后肠道黏膜屏障损伤，通透性增加极易导致肠道细菌移位。目前研究表明，肠道细菌移位与SIRS关系密切，肠道细菌移位的存在可能增加多器官功能障碍综合征患者的死亡率[2，3]。本研究采用全血细菌DNA PCR技术评价胰十二指肠切除术后患者细菌移位，并探讨其与肠黏膜屏障损伤及SIRS的关系。
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