脓毒症患者肠屏障功能损伤的临床研究

摘要

Objective To investigate the intestinal barrier dysfunction in sepsis and septic shock patients,and to analyze the relationship between infection site and the severity of the disease.Methods A prospective observational research was carried out in 42 sepsis patients,47 septic shock patients and 36 postoperative patients without sepsis as control admitted to Department of Critical Care Medicine of General Hospital of Ningxia Medical University from November 2015 to June 2017.Blood samples were collected from patients on the first day and the third day after admission to the intensive care unit (ICU) to measure D-lactic acid and endotoxin levels of sepsis and septic shock patients by enzymatic method,while the blood sample of control group was just tested on the first day.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score of patients were recorded on the first day after admission.Sepsis and septic shock patients were divided into intra-abdominal infection group(n=54) and extra-abdominal infection group(n=35).Results (1) Compared with control group,D-lactic acid and endotoxin levels in sepsis patients and septic shock patiems were significantly higher on the first day and third day (all P＜0.01).There were no significant differences in D-lactic acid and endotoxin between sepsis group and septic shock group on the first day (both P＞0.05),but endotoxin level of septic shock group was higher than that in sepsis group(P＜0.05) and there was no significant differences in D-lactic acid level between these two groups (P＞0.05) on the third day.(2) In the intra-abdomen infection group,there were no significant differences in D-lactic acid and entotoxin between sepsis patients and septic shock patients on the first day and the third day after admission (all P＞0.05).(3)There were no significant differences in D-lactic acid and endotoxin between intra-abdominal infection group and extra-abdominal infection group on the first day and the third day after admission(all P＞0.05).Conclusions Sepsis and septic shock patients often have intestinal barrier dysfunction.The dysfunction is correlated with the severity of disease,but there is no relationship with the infective site.Endotoxin is superior to blood D-lactic acid in reflecting the severity of sepsis.%目的 探讨脓毒症、脓毒症休克患者肠屏障功能损伤的变化,分析损伤与感染部位及疾病严重程度的关系.方法 采用前瞻性观察性研究方法,纳入2015年11月至2017年6月收住宁夏医科大学总医院重症医学科(ICU)的脓毒症患者42例(脓毒症组)、脓毒症休克患者47例(脓毒症休克组),并选取同期入住宁夏医科大学总医院ICU的普通术后未并发脓毒症的患者36例(对照组).分别采用酶法测定各组患者入ICU第1天、第3天血清D-乳酸、细菌内毒素水平(对照组仅测第1天).记录各组患者入ICU第1天急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭(SOFA)评分.脓毒症组和脓毒症休克组患者依据感染部位分为腹腔感染组(54例)和非腹腔感染组(35例).结果 (1)组间比较:入住ICU第1天、第3天脓毒症组及脓毒症休克组血D-乳酸及内毒素水平均明显高于对照组(均P＜0.01).人住ICU第1天脓毒症组与脓毒症休克组血D-乳酸与内毒素水平比较,差异均无统计学意义(均P＞0.05),入住ICU第3天脓毒症休克组内毒素水平高于脓毒症组(P＜0.05)、血D-乳酸水平比较,差异无统计学意义(P＞0.05).(2)组内比较:脓毒症和脓毒症休克组入ICU第1天与第3天血D-乳酸及内毒素水平组内比较,差异均无统计学意义(均P＞0.05).(3)入ICU第1天、第3天腹腔感染组与非腹腔感染组血D-乳酸及内毒素水平比较,差异均无统计学意义(均P＞0.05).结论 脓毒症、脓毒症休克患者均发生了肠道屏障损伤,损伤的发生与感染部位无关,而与疾病的严重程度存在一定关系;且内毒素在反映脓毒症疾病严重程度上优于血D-乳酸.