严重多发伤患者早期血浆内毒素水平变化及与胃肠功能障碍的关系

Changes of plasma endotoxin levels in multiple-injury patients and its relation with gastrointestinal dysfunction

目的探讨严重多发伤患者血浆内毒素水平的变化及其与创伤后胃肠功能障碍的关系。方法将27例多发伤患者分为轻伤组(ISS评分<16分)12例,重伤组(ISS评分>16分)15例;将27例多发伤患者分为非胃肠功能障碍组6例和胃肠功能障碍组21例;设正常对照组10例,正常对照组采静脉血1次,27例多发伤患者于伤后第1、3天采静脉血2次,应用动态浊度法检测血浆内毒素变化。结果与正常对照组相比,轻伤与重伤组血浆内毒素水平在伤后1、3天均明显升高(P<0.01);重伤组伤后第3天血浆内毒素水平较轻伤组明显升高(P<0.01);创伤后第3天胃肠功能障碍组与非胃肠功能障碍组血浆内毒素水平差异显著,其内毒素水平与胃肠功能障碍程度相关性显著。结论严重创伤后血浆内毒素水平明显升高,其变化不仅与伤创的严重程度有关还与肠功能障碍密程度密切相关,这种动态变化可能对早期预测创伤后胃肠功能障碍具有一定的临床价值。

Objective To explore the relation between gastrointestinal dysfunction and the level of plasma endotoxin in severe multiple-injury patients. Methods Twenty-seven multiple-injury patients were divided into minor-injury （ ISS 〈 16 ） group（ 12cases ） and severe multiple-injury （ ISS 〉 16 ） group （ 15cases ）. They were divided into non-gastrointestinal dysfunction group （ 6cases ） and gastrointestinal dysfunction group （ 21cases ）. Another 10 healthy people served as the control group. Venous blood was collected for one time in the control group and in other groups, venous blood were collected on the 1 st and 3rd day after trauma. The concentration of endotoxin were determined by dynamic turbidity method. Results The endotoxin level of the minor-injury group and severe-injury group were both higher than that of the control group on the 1st and 3rd day after trauma,and the endotoxin level of the sever-injury group was remarkably higher than that of the minor-injury group on the 3rd day after trauma. On the 3rd day after trauma the plasma endotoxin level of gastrointestinal dysfunction group was remarkablely higher than that of non-gastrointestinal group. The level of endotoxin was highly relevant to the degree of gastrointestinal dysfunction. Conclusion The results suggested that the level of endotoxin rises obviously after severe trauma and the change of the level is not only relevant to the severity of trauma,but also closely to the degree of the gastrointestinal dysfunction. The observation of change of plasma endotoxin level may be effective to predict the gastrointestinal dys- function after severe trauma.