肠源性内毒素血症的器官功能状态观察

Observation on Fnctional State of Organs in Intestinal Endotoxemia

目的:了解外科危重病中肠源性内毒素血症的变化规律,以及它与器官功能、免疫状态和预后的相关性。方法:对41例存在肠功能障碍的外科ICU病人,观察治疗前、治疗后第3d和7d的APACHEⅡ评分,器官功能损害数目,内毒素水平,细胞因子,免疫状态的特点。结果:按预后分组,治愈组和好转组的L/M、内毒素水平在治疗后第7d均有下降,有统计学意义,死亡组则显著升高。治愈组的Th1/Th2漂移在治疗后第3d和7d均有统计学意义,死亡组的Th1/Th2第3d即有明显的下降趋势,第7d显著低于正常值。HLA-DR于治疗后第7d治愈组的升高有统计学意义,死亡组HLA-DR则显著降低。结论:在外科危重病中,器官损害数目的增加,内毒素水平、尿L/M的进行性升高,Th1/Th2显著降低和HLA-DR表达低下,均是判断预后不良的重要指标。

Objective To explore the developing regulations of intestinal endotoxemia in critical patients. To investigate the relationship between intestinal endotoxemia and functional status of the organs and immunity. Methods Forty one critical surgical patients suffering from gut dysfunction and MODS were prospectively observed. On the 1st, 3rd and 7th days the APACHE-Ⅱ score, the numbers of the organs with functional lesions, the blood level of endotoxin, and the characteristics of eytokines and immune status were observed. Results The L/M and the level of the endotoxin in the curing group and survival group descended on the 7th day, with statistical significance, but those in the death group increased obviously. The migration of Th1Th2 in the curing group had statistical siguificanees on the 3rd and 7th day. However, the Th1/Th2 in the death group showed a clear downtrend on the 3rd day, and obviously lower than the normal range on the 7th day. The increase of HLA - DR in the curing group on the 7th day had statistical signifieances, but in the death group descended significantly. Conclusion In surgical critical patients, the number of organs with functional lesions increases, the level of urine L/M and blood endotoxin increases, the Th1Th2 decreased significantly, with lower expression of HLA - DR, showing important indexes for bad prognosis.