摘要
目的 探讨选择性消化道灭菌 (SDD)对肠源性内毒素血症的预防作用。方法 Wistar大鼠 60只 ,胰管逆行灌注法复制急性坏死性胰腺炎 (ANP)模型 ,设立正常对照组、假手术组、ANP组和SDD治疗组 (ANP后喂服三联抗生素 ) ,记录发病 72小时组织学、血清TNFα、IL 1β、肠道菌群、血浆D 乳酸 (肠通透性指标 )和内毒素含量及病死率。结果 SDD使ANP胰腺和小肠病理改变减轻 ,TNFα水平下降 (P<0 .0 1)。ANP时肠道大肠杆菌等条件致病菌过度繁殖 ,双歧杆菌数量减少 ,SDD抑制了致病菌的繁殖 ,双歧杆菌数量不变 ,双歧杆菌 /大肠杆菌比值 (B/E值 )回升 (P<0 .0 1)。SDD组血浆D 乳酸由 ( 8.0 5 ±3.0 5 )mg/L降至 ( 3.95±1.83)mg/L(P <0 .0 1) ,门静脉内毒素由 ( 0 .42 3±0 .15 5 )EU/ml下降至 ( 0 .2 2 7±0 .0 84)EU/ml(P<0 .0 1)。ANP组 72小时病死率为 5 8.8% ,SDD组为 14 .3% (P=0 .0 0 5 )。结论 SDD可减少肠道革兰氏阴性菌含量 ,保护正常菌群 ,维护肠屏障 ,减轻了ANP时肠源性内毒素血症 ,有助于提高ANP的生存率。
Objective To investigate the preve nt ive role of selective decontamination of the digestive tract (SDD) in gut-ori ginated endotoxemia in acute necrotizing pancreatitis (ANP). Methods A lethal model of ANP was reproduced i n Wistar rats by retrograde infusion of artificial bile into the main pancreatic duct. Normal control group (n=6), sham operation group (n=6), ANP group (n=14) and ANP+SDD (polymycin E, tobramycin and nystatin mixture) group ( n=8) were randomly devided. Visceral pathologic changes, serum levels of TNFα and IL-1β, intestinal bacterial flora, plasma D-)- lactate and endotoxin contents, as well as the mortality were examined at 72h af ter operation in each group. Results Necrosis and inflammation of pancreas, with a remarkable elevation of serum TNFα and IL-1β and intestinal flora dist urbance (with E.Coli content risen significantly) were seen in ANP rats. Sim ultaneously, ANP rats displayed elevated plasma concentration of D-lactate and endotoxin. In SDD group, enterobacteraceae and yeast wer e markedly depressed, while anaerobes were well preserved, with the value of B/E 〔Bifidobacterium/E.Coli, log_1_0(CFU/CFU)〕 elevated in the ileac mucou s membrane (1.73±1.23 vs - 0.37±0.72 in ANP group,P <0.01) and in the caecum content (∞ vs 0.88±0.77). In addition, depressed levels of D(-)-lactate 〔(3.95±1.83) mg/L vs (8.05±3.05) mg/L in ANP group,P<0.01〕, endotoxin 〔(0.227±0.084) EU/ml vs (0.423±0.155) EU/ml in ANP group, P<0.01〕 and TNFα 〔(15.41±10 .32) ng/L vs (46.79±24.31) ng/L in ANP group P<0.01〕 in systemic or portal vein were observed in the SDD group. Moreover, SDD group displayed a declined 72h mor tality(14.3% vs 58.8% in ANP group, P =0.005). Conclusion ANP is associated with gut barrier disorder and gut flora imbalance, which may exacerbate the process of gut-origi nated endotoxin translocation. By protecting gut flora and gut barrier against d isorder, SDD attenuates ANP-related endotoxemia and improves the outcome. SDD i s advisable for th
出处
《中国普外基础与临床杂志》
CAS
2001年第6期361-363,366,共4页
Chinese Journal of Bases and Clinics In General Surgery
