选择性消化道去污联合谷氨酰胺预防兔背驮式肝移植肠道细菌易位

Joint Effects of Selective Digestive Decontamination and Glutamine on Intestinal Bacterial Translocation of Piggyback Liver Transplantation in Rabbit

目的观察选择性消化道去污(SDD)联合谷氨酰胺(Gln)对兔原位背驮式肝移植肠道细菌易位及术后肺部感染的预防作用。方法建立兔原位背驮式肝移植模型30例,受体兔被随机均分为SDD组、SDD+Gln组及对照组。SDD组给予含妥布霉素、多黏菌素E及制霉菌素的乳剂处理;SDD+Gln组在SDD的基础上加以Gln;对照组仅建立移植模型。各组分时段抽取门静脉血,获取回肠组织标本及术后肺组织标本,观察回肠组织病理变化、门静脉血细菌易位及术后肺部感染情况。结果门静脉阻断15、30、45min及术后30h SDD+Gln组回肠壁毛细血管混合切面面积均小于对照组(P<0.05,P<0.01)和SDD组(P<0.05)。门静脉阻断前SDD+Gln组回肠绒毛长度较对照组(P<0.05)和SDD组(P<0.05)长,在门静脉阻断45min时段对照组超过SDD+Gln组(P<0.05)和SDD组(P<0.05),术后又回返至术前状态(P<0.05,P<0.01)。门静脉阻断45min和术后30h时段SDD+Gln组及SDD组门静脉血细菌培养阳性者少于对照组(P<0.05,P<0.01)。SDD+Gln组及SDD组术后肺部感染者也少于对照组(P<0.05,P<0.01)。结论Gln对肠黏膜上皮细胞具有较强的营养作用,与SDD联用可以有效地降低门静脉阻断期间及术后肠道细菌易位及术后肺部感染的发生。

Objective To investigate the joint effects of selective digestive decontamination （SDD） and glutamine （Gln） on preventing intestinal bacterial translocation of orthotopic piggyback liver transplantation and to observe the incidence of postoperative pneumonia in rabbit. Methods Thirty rabbits received orthotopic piggyback liver transplantation and were randomly divided into three groups （SDD group, SDD＋Gln group and control group）. Mixed emulsion of tobramycin, polymyxin E and nystatin were given to the rabbits in SDD group. Same dosage of the above components plus Gin were given to the rabbits in SDD＋Gln group. Samples of portal vein blood, ileum tissue and lung tissue were obtained in each group at different phases during and after operation, the pathological changes of ileum tissue, the bacterial translocation in blood of portal vein and the incidence of postoperative pneumonia were detected. Results The mixing section area of intestinal blood capillaries in SDD＋Gln group was smaller compared with control group （P〈0.05, P〈0.01） and SDD group （P〈0.05） while the portal vein was obstructed for 15, 30 and 45 min, and after the operation, respectively. The length of ileum villus in SDD＋Gln group was longer than that in control group （P〈0.05） and in SDD group （P〈0.05） before the portal vein was obstructed, but the length of ileum villus in control group gradually became longer and eventually exceeded that in SDD＋Gln group at the time of 45 rain after the portal vein was obstructed （P〈0.05）. After the operation, the length of ileum villus in SDD＋Gln group was significantly longer than that in SDD group （P〈0.05） and control group （P〈0.01）. At the time of 45 rain after the obstruction of portal vein and 30 hours after operation, the positive rate of cultured bacterial in the blood of portal vein in SDD＋Gln group was significantly lower than that in control group （P〈0.05, P〈 0.01）. The incidence of postoperative pneumonia in SDD＋Gln group and SDD group were significantly lower than that in control group （P〈0.05,P〈0.01）. Conclusion Gln could nourish intestinal epithelium of mucous membrane. When combined with SDD, it could decreased the incidence of intestinal bacterial translocation occurred during the obstruction of portal vein and after operation, so as to decrease the incidence of postoperative pneumonia.