摘要
目的研究脓毒症病人肠黏膜屏障功能损伤与病情严重程度和预后的相关性。方法以2016年9月至2019年9月廊坊市人民医院收治的126例脓毒症病人为研究对象,包含脓毒症61例和脓毒症休克65例;依据重症病人急性胃肠损伤分级(AGI)分为胃肠功能正常22例,Ⅰ级20例、Ⅱ级35例、Ⅲ级43例、Ⅳ级6例);依据病人出院结局分为85例生存组和41例死亡组。另选同期门诊健康体检者57例作为对照组。比较各组二胺氧化酶(DAO)、D-乳酸、肠型脂肪酸结合蛋白(I-FABP)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)和血气指标。结果脓毒症休克组DAO、D-乳酸、IFABP、APACHEⅡ、SOFA评分及二氧化碳分压(PaCO_(2))为(11.29±1.89)mg/mL、(37.27±4.86)mg/L、(4987.03±682.12)mg/L、(25.96±3.28)分、(13.14±1.85)分、(51.16±7.44)mmHg,高于脓毒症组的(8.71±0.91)mg/mL、(20.15±3.15)mg/L、(1267.55±158.03)mg/L、(16.31±2.17)分、(9.25±1.49)分、(43.10±6.77)mmHg,且高于对照组的(3.08±0.41)mg/mL、(10.29±1.37)mg/L、(861.84±103.29)mg/L、(11.29±1.27)分、(1.21±0.13)分、(34.28±4.28)mmHg。脓毒症休克组动脉血氧分压(PaO_(2))低于脓毒症组,且低于对照组的,差异有统计学意义(P<0.05)。脓毒症组+AGIⅣ级组DAO、D-乳酸、IFABP、APACHEⅡ、SOFA评分及PCO_(2)高于脓毒症组+AGIⅢ级、脓毒症组+AGIⅡ级、脓毒症组+AGIⅠ级和脓毒症胃肠功能正常组,PaO_(2)低于脓毒症组+AGIⅢ级、脓毒症组+AGIⅡ级、脓毒症组+AGIⅠ级和脓毒症胃肠功能正常组,差异有统计学意义(P<0.05)。死亡组DAO、D-乳酸、IFABP、APACHEⅡ、SOFA评分及PCO_(2)高于生存组,PaO_(2)低于生存组,差异有统计学意义(P<0.05)。脓毒症病人DAO、D-乳酸、IFABP和APACHEⅡ、SOFA评分及PCO_(2)呈正相关,和PaO_(2)呈负相关。结论脓毒症病人肠黏膜屏障功能损伤能够增加病人病死率,临床测定肠黏膜屏障功能情况能够反映病
Objective To study the correlation between intestinal mucosal barrier dysfunction and severity and prognosis in septic patients.Methods From September 2016 to September 2019,126 patients with sepsis admitted to the Department of Intensive Medicine of Langfang People's Hospital were selected as the research subjects,including 61 patients with sepsis and 65 patients with septic shock.According to the acute gastrointestinal injury classification(AGI)of severe patients,there were 22 cases with normal gastrointestinal function,20 cases with grade I,35 cases with gradeⅡ,43 cases with gradeⅢand 6 cases with gradeⅣ.Another 57 outpatients were selected as control group.According to the discharge outcome,the patients were divided into 85 survival groups and 41 death groups.The diamine oxidase(DAO),D-lactic acid,intestinal fatty acid binding protein(I-FABP),acute physiology and chronic health status(APACHEⅡ),sequential organ failure score(SOFA)and blood gas index were compared in each group.Results In the septic shock group,DAO,D-lactic acid,IFABP,APACHEⅡ,SOFA score and carbon dioxide partial pressure(PaCO_(2))were(11.29±1.89)mg/mL,(37.27±4.86)mg/L,(4987.03±682.12)mg/L,(25.96±3.28),(13.14±1.85),(51.16±7.44)mmHg,which were higher than those in the septic group(8.71±0.91)mg/mL,(20.15±3.15)mg/L,(1267.55±158.03)mg/L,(16.31±2.17),(9.25±1.49),(43.10±6.77)mmHg,and higher than those in the control group(3.08±0.41)mg/mL,(10.29±1.37)mg/L,(861.84±103.29)mg/L,(11.29±1.27),(1.21±0.13),(34.28±4.28)mmHg,the partial pressure of oxygen(PaO_(2))in septic shock group,which were lower than those in the septic shock group,and lower than those in the control group,the difference were statistically significant(P<0.05).The scores of DAO,D-lactic acid,IFABP,APACHEⅡ,SOFA and PCO_(2) in septic group+AGIⅣwere higher than those in septic group+AGIⅢ,septic group+AGIⅡ,septic group+AGIⅠand septic gastrointestinal function normal group,PaO_(2) was lower than those in septic group+AGIⅢ,septic group+AGIⅡ,septic group
作者
李青
杨明
田雪
LI Qing;YANG Ming;TIAN Xue(Department of Emergency,People's Hospital of Langfang City,Langfang,Hebei 065000,China;Department of Gynecology and Obstetrics,Langfang Hospital of Traditional Chinese Medicine,Langfang,Hebei 065000,China)
出处
《安徽医药》
CAS
2022年第10期2072-2076,共5页
Anhui Medical and Pharmaceutical Journal
关键词
脓毒症
肠黏膜
胺氧化酶(含铜)
高乳酸血症
脂肪酸结合蛋白质类
预后
Sepsis
Intestinal mucosa
Amine oxidase(copper-containing)
Hyperlactatemia
Fatty acid-binding proteins
Prognosis
