摘要
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48h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30d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2h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2h)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。
Objective To investigate bacterial translocation in severe muhiple trauma patients using polymerase chain reaction （PCR） to detect the presence of bacteria in the blood. Methods Sixteen severe multiple trauma patients [injury severity score （ISS）2〉203 in surgery intensive care unit （SICU） were selected. Blood samples were collected 2, 24 and 48 hours after trauma for bacterial culture and microbial DNA detection. Meanwhile, plasma levels of D- lactate and lipopolysaccharide （LPS） in systemic circulation were determined. PCR was performed after DNA extraction, with target β- lactosidase gene of E. coil and 16SrRNA gene of most pathogenic bacteria. All patients were observed within 30 days for infectious complications. D lactate and LPS levels were determined in 63 patients before selective operation. Results Microbial DNA could be detected in blood as early as 2 hours following severe trauma, and altogether positive results were found in 10 patients （62.50%）, All PCR- positive patients manifested sepsis, but none of the PCR -negative patients did （P〈0.01）, Bacterial DNA was discovered in 100, 00% of sepsis patients and none in non -sepsis patients （P〈0.01）. Seventy percent of PCR positive patients developed infectious complications, while none of PCR- negative patients did （P〈0. 01）, The blood culture was positive only in 3 patients （18.75%）, all of them were PCR -positive. E, coil DNA was found in 70. 00~ of all the PCR positive blood specimens, Systemic plasma concentration of D- lactate and LPS of all patients was significantly higher than that in control group, which consisted of 63 inpatients waiting for elective operations. Systemic plasma level of D - lactate showed a positive correlation with that of LPS （r= 0.94, P〈0.01 ）, Conclusion Intestinal bacterial translocation （most commonly E. coli） might occur early （2 hours） after severe trauma. Infection and sepsis have a close relationship with bacterial translocation, Detection of blood microbial DNA
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2006年第1期13-15,共3页
Chinese Critical Care Medicine
基金
全军医学科研"十五"计划面上项目(01MA207)
