选择性肠道去污和盲肠造口/结肠灌洗对猪急性重症胰腺炎后肠源性细菌/内毒素移位的影响

Influence of SDD and Caecostomy/Colonic Irrigation on Gut Endotoxin/Bacteria Translocation following Acute Severe Pancreatitis.

目的:观察选择性肠道去污(SDD)和盲肠造口、结肠灌洗对猪急性重症胰腺炎(ASP)后肠源性细菌/内毒素移位的影响。方法:选健康长白种猪23头,体重16 ks^22 kg,雌雄不限,随机分为4组:组Ⅰ:假手术对照组(n=5);组Ⅱ:ASP对照组(n=6);组Ⅲ:ASP+SDD预防组(n=6);组Ⅳ:ASP+盲肠造口、结肠灌洗组(n=6)。在麻醉状态下,进腹向胰总管注入1 ml／kg·BW 5％牛磺胆酸钠混合液(内含8 000~10 000 BAEE单位胰蛋白酶/ml,pH7.6)诱导ASP。假手术对照组以0.9％NaCl磷酸盐缓冲液取代5％牛磺胆酸钠混合液。分别于ASP诱导前30 min、诱导后6 h、24 h、48 h、72 h采集腔静脉血作内毒素(LPS)测定(鲎试剂法)。ASP后72 h,采集门、腔静脉血及大小肠系膜淋巴结、肺组织、肺门淋巴结、胰腺组织作系列细菌定量培养和细菌鉴定。结果:预防性SDD不仅可非常显著地降低粪便培养中肠杆菌数(P<0.01),而且使血浆LPS水平明显下降,血和组织器官中移位细菌数量明显降低。盲肠造口、结肠灌洗亦可有效地降低血浆内毒素水平及组织器官中移位细菌数量。结论:预防性SDD或盲肠造口／结肠灌洗均可有效地减少胰腺炎性肠道细菌/内毒素移位,尤其后者可能具有重要的临床指导意义。

Objective To observe the influence of the selective digestive tract decontamination (SDD) and caecos-tomy/colonic irrigation on gut endotoxin/bacteria translocation following acute severe pancreatitis (ASP) . Methods Twentythree pigs weighing 16-22 kg, were divided into four groups. Group Ⅰ (n = 5): sham-control; Group Ⅱ (n = 6): ASP-control; Group Ⅲ (6) : gentamicin(8.55 × 105 ± 5.70 × 104 units) and nystatin( 1.37 × 105 ± 9.00 × 103 units) were fed orally every 8h for 1 week before the induction of ASP; Group Ⅳ (n = 6) : caecostomy was created before the induction of ASP and ASP was induced by injecting 1 ml/kg· BW of mixed solution of 5% sodium taurocholate and 8 000 ~ 10 000 BAEE units trypsin/ml into pancreas via pancreatic duct. Systemic plasma endotoxin levels were quantified by the chromogenic limulus amebocyte lysate(LAL) technique. Specimens of tissue from mesentery and mesocolon lymph nodes, lung, lung hilum lymph nodes, pancreas and the sampales of both portal and systemic blood were collected before and at 72h following ASP for bacterial culture and identification. Results Preventive SDD not only effectively reduces the amount of bacteria in stool( P < 0.01), but also reduced significantly the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organs and tissues(i. e., mesenteriy and mesocolon lymph nodes, lung, lung hilum lymph nodes and pancreas. Early caecostomy/colonic irrigation can also reduced significantly the levels of translocated origin-endoxin and bacteria after ASP. Conclusion SDD and caecostomy/colonic irrigation reduce effectively the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organs, especially the latter might be of a helpful measure in the future clinical practice.