风心病术前肠道联合用药对内毒素血症的影响

The Effect of Preoperative Bowel Preparation on Endotoxemia of Patients with Rheumatic Heart Disease

目的:探讨术前肠道联合用药对体外循环(CPB)风温性心脏病瓣膜置换术病人术后肠源性内毒素血症的影响。方法:选择风湿性心脏病瓣膜置换术CPB病人30例,随机分为对照组和用药组各15例。对照组行常规术前肠道准备;用药组在常规准备的基础上肠道联合用药。检测两组病人在诱导麻醉、CPB结束、CPB后2 h、24 h 4个时相点循环D-乳酸、内毒素、TNF-α和补体C3值。结果:用药组病人循环D-乳酸水平在诱导麻醉和CPB后2 h显著低于时照组(P<0．05)。两组病人CPB后体内内毒素水平皆显著增高(P<0．05),而用药组在CPB结束(P<0．01)及CPB后24 h(P<0．05)的内毒素水平皆显著低于对照组。结论:CPB心内直视术引发内毒素血症,而术前肠道联合用药是预防内毒素血症的有效肠道准备方法。

Objective： To eveluate the effect of preoperatine bowel preparation on intestinal derived endotoxmia in patients of rheumatic heart disease undergoing valve replacement operation. Method： Thirty patients were divided into control group and treatment group randomly, control group were routinely performed preoperative preparation while those in treatment group orally administrated combining anti - becterial agents in addition to routinely preoperative bowel preparation. The level of endotoxine, D-lactate , TNF-α and C3 were determined at four points of anesthetic induction,CPB end,2 h after CPB and 24 h after CPB. Result： The D-lactate level of treatment group reduced significantly at points of anesthetic induction and 2 h after CPB （ P 〈 0.05 ） compared with that of the controlled group. Endotoxine level of two groups increased significantly after CPB （ P 〈 0.05 ）, and endotoxine level of treatment group decreased significantly at points of CPB end （ P 〈 0.01 ） and 24 h after CPB （ P 〈 0.05 ） compared with that of control group. Condusion： CPB induces endotoxemia, while bowel preparation is a effective way to prevent endotoxemia,