外科病人手术前后血中细菌DNA检出率的研究

The percentage of bacterial DNA in in blood of surgical patients

目的用稳定可靠的PCR方法，检测腹部手术前后血中以肠源性细菌为主的DNA并与相关因素进行分析。方法111例择期腹部手术病人在术前，术后第3天、第6天各采血3ml进行检测。患者按手术创伤大小分为三组，又按术后是否存在“全身性炎症反应综合征”（SIR）分为二组，不同组别与PCR阳性率进行对比。结果术前PCR均为阴性。术后第3天PCR阳性率17．1％（19／111），高于术后第6天PCR阳性率6，3％（7／111，P＝0．004）。大手术组PCR阳性率为32．4％（11／34），中手术组为13．4％（9／67），小手术组为10％（1／10），三组之间有差异（P＝0．02）。术后出现SIRS的病人PCR阳性率为43．9％（18／41），高于无SIRS组4．3％（3／70，P=0．001）。结论术后禁食输液治疗病人血中可检出细菌DNA，阳性率与手术创伤大小、术后有无SIRS可能有关。

Shock, trauma, long-time parenteral nutrition may be related to gut bacterial translocation, yet no study of detecting gut bacterial DNA in surgical patients by polymerase (PCR) was reported in China. Obejctive To detect bacterial DNA in the blood of laparotomy patients using PCR technology, and compare the PCR results with some other factors. Methods Blood of 111 patients undergoing selective laparotomy was Collected (before surgery,3rd day and 6th day after surgery). The patients were divided into three groups according to the severity of surgical injury and according divided into SIRS and no-SIRS groupe to whether they developed systemic inflammatory reaction syndrome (SIRS) after operation. Results No bacterial DNA was detected before surgery. The positive rate of PCR on the third day were 17.1 % (19/111), higher than that on the sixth day 6. 3% (7/111), (P = 0. 004). The percentage of bacterial DNA present in blood samples of patients undergoing major, median and minor surgery was 32. 4%, 13. 4% and 10% respectively (P =0. 02). Bacterial DNA was detected in 43.9% (18/42) SIRS patients and 4.3% (3/70) non SIRS patient (P =0. 001).Conclusions Bacterial DNA debris was detected in patients after laparotomy and may be related to the time of blood collection, severity of surgical injury and whether patients develop SIRS.