应用血浆D-乳酸水平评价腹部外科手术后肠道屏障功能

Plasma D-lactate levels as a useful marker of increased intestinal permeability and gut barrier dysfunction in patients after intraperitoneal operations

目的 评价腹部外科手术后肠道屏障功能,探讨腹部外科手术后患者肠道屏障损伤的规律。方法 将63例患者按不 同标准分组:胃肠手术组和非胃肠手术组;大手术组和中等手术组;术后发生全身性炎症反应综合征(SIRS)组和未发生SIRS组。术 前和术后2、24、48h采集外周血,采用分光光度法和酶联法测定血浆D- 乳酸和内毒素(LPS)水平,不同组别间进行对比,同时将D- 乳 酸及LPS结果进行相关性分析。结果 SIRS组术后2h血浆D 乳酸即开始升高,在术后24h达到高峰并维持至48h,术后各时间点 D -乳酸水平与无SIRS组比较差异有统计学意义(P<0.01)。大手术组血浆D -乳酸水平与中等手术组比较差异亦有统计学意义(P< 0.01)。胃肠手术组与非胃肠手术组术后各时间点血浆D -乳酸水平比较差异无统计学意义(P>0.05)。外周血浆D -乳酸水平与LPS 水平呈显著正相关(r=0.91,P<0.01)。结论 血浆D- 乳酸可作为临床腹部外科手术所致肠黏膜屏障损伤、肠道细菌移位、肠源性内 毒素血症形成的预警指标。

Objective To determine the kinetic changes of plasma D-lactate and endotoxin levels in patients after intraperitoneal operations. Methods Blood samples of 63 patients undergoing selective laparotomy were collected 0, 2, 24 and 48h after surgery. According to various criteria, the patients were divided into two groups respectively, i.e. extensive operation or medium sized operation,involvement of gastrointestinal (GI) tract or non-involvement GI tract, and development of symptoms of SIRS or no SIRS after operation. Plasma levels of D-lactate and endotoxin in systemic circulation were determined. Results The analytical data showed that the plasma levels of D-lactate and endotoxin were elevated significantly at 2, 24 and 48h post laparotomy in SIRS patients and major surgery group, and there was also a significant correlation between the plasma levels of D-lactate and endotoxin(γ=0.91,P<0.01). Conclusion The result suggested that the plasma D-lactate level may be a useful marker to evaluate the degree of intestinal injury, bacterial translocation and endotoxemia following abdominal operations.