严重烫伤后肠源性感染与肠淋巴循环

Intestinal lymphatic circulation is one of the important portals for microbial translocation after thermal in jury.

为了探索严重烫伤后肠腔内的细菌和内毒素能否通过肠淋巴循环向全身播散,我们选用Wistar 大鼠46只,制作大鼠肠淋巴瘘模型,随后分为烫伤组和对照组,分别在烫伤前和烫伤后3、6、12、24小时收集肠淋巴液,动态检测肠淋巴液内毒素清除量,肠道细菌培养阳性率及菌量,以及回肠粘膜病理学检查。结果表明:烫伤后肠淋巴液内毒素清除量和肠道细菌阳性率及菌量明显增加;病理学检查发现:回肠绒毛中央乳糜管明显扩张,肠上皮细胞坏死脱落。提示:肠淋巴循环是严重烫伤后肠源性感染的另一重要途径;肠粘膜屏障受损是发生肠源性感染的重要因素。

The goal of this study was to determine whether the bacteria and endotoxin from GI tract could pass through the intestinal lymph circulation to the systemic circulation after severe thermal injury. Lymphatic fistula of intestine was created in 46 Wistar rats,the rats were then divided randomly in scald and control groups.In scald group,animals were sustained with 30% TBSA full-thickness scald.The items studied were:the dynamic changes in intestinal lymph endotoxin level,the qualitative and quantitative bac- terial culture,and pathological alterations in ileal mucosa within 24 hours postburn.Results showed that the levels of intestinal lymph endotoxin and the positive culture rate and counting of bacteria were evidently in- creased,and ileal mucosal lacteals were dilated and epithelial cells were necrotic and denudated in scald group.These suggested that the intestinal lymph circulation is one of the important portals for endotoxin and microbial translocation after severe thermal injury,and the intestinal mucosal damage is an important factor in pathogenesis.