• 1.解放軍三○四醫(yī)院普外科（北京100037）;;
  • 2.解放軍三○四醫(yī)院中心研究室;

目的  探討選擇性消化道滅菌(SDD)對腸源性內(nèi)毒素血癥的預防作用。方法  Wistar大鼠60只，胰管逆行灌注法復制急性壞死性胰腺炎(ANP)模型，設立正常對照組、假手術組、ANP組和SDD治療組(ANP后喂服三聯(lián)抗生素)，記錄發(fā)病72小時組織學、血清TNFα、IL-1β、腸道菌群、血漿D-乳酸(腸通透性指標)和內(nèi)毒素含量及病死率。 結(jié)果  SDD使ANP胰腺和小腸病理改變減輕，TNFα水平下降(P＜0.01)。ANP時腸道大腸桿菌等條件致病菌過度繁殖，雙歧桿菌數(shù)量減少，SDD抑制了致病菌的繁殖，雙歧桿菌數(shù)量不變，雙歧桿菌/大腸桿菌比值(B/E值)回升(P＜0.01)。SDD組血漿D-乳酸由(8.05±3.05) mg/L降至(3.95±1.83) mg/L(P＜0.01)，門靜脈內(nèi)毒素由(0.423±0.155) EU/ml下降至(0.227±0.084) EU/ml(P＜0.01)。ANP組72小時病死率為58.8%，SDD組為14.3%(P＝0.005)。結(jié)論  SDD可減少腸道革蘭氏陰性菌含量，保護正常菌群，維護腸屏障，減輕了ANP時腸源性內(nèi)毒素血癥，有助于提高ANP的生存率。

引用本文： 鄧群,黎沾良,熊德鑫. 選擇性消化道滅菌對急性胰腺炎腸源性內(nèi)毒素血癥的預防作用. 中國普外基礎與臨床雜志, 2001, 8(6): 361-363下轉(zhuǎn)366. doi: 復制

版權(quán)信息： ?四川大學華西醫(yī)院華西期刊社《中國普外基礎與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

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  2. 2. Tokyay R, Zeigler ST, Traber DL. Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation 〔Ｊ〕. J Appl Physiol, 1993; 74(4)∶1521.
  3. 3. Smith SM, Eng HK, Buccini F. Use of Dlactic acid measurement in the diagnosis of bacterial infections 〔Ｊ〕. J Infect Dis, 1985; 154(4)∶658.
  4. 4. Yao YM, Yu Y, Wu Y, et al. Plasma D(-)lactate as a new marker for diagnosis of acute intestinal injury following ischemiareperfusion 〔Ｊ〕. China Natl J New Gastroenterol, 1997; 3(4)∶225.
  5. 5. Runkel WSF,Moody FG,Smith GS,et al. The role of the gut in the development of sepsis in acute pancreatitis 〔Ｊ〕. J Surg Res, 1991; 51(1)∶18.
  6. 6. Manson WL, Klasen HJ, Sauer EW, et al. Selective intestinal decontamination for prevention of wound colonization in severily burned patients: a retrospective analysis 〔Ｊ〕. Burns, 1992; 18(2)∶98.
  7. 7. Lingnau W, Berger J, Javorsky F, et al. Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial 〔Ｊ〕. J Trauma, 1997; 42(4)∶687.