创伤早期内毒素血症

Endotoxemia during early stages after trauma

目的：探讨严重创伤患者早期内毒素血症参与早期全身炎症反应的可能性和其变化趋势对评估预后的意义。方法：监测２５例严重创伤患者伤后２４小时～２８日的内毒素水平和血液细菌学培养，１０例患者行血流动力学监测（７２小时）；２２例健康成人血标本的内毒素值作对照。结果：全组患者可以早至伤后２４小时内即发生内毒素血症〔（３６１±６０１）ＥＵ／Ｌ（ＥＵ为内毒素单位）〕，与正常健康人〔对照组血内毒素（７４±２３）ＥＵ／Ｌ〕比较，Ｐ＜０．０５；１０例行血流动力学监测者表现典型的高动力型循环和高代谢状态；存活组内毒素呈下降趋势，至伤后７日〔（１２５±１９８）ＥＵ／Ｌ〕与对照组差异不显著；死亡组与ＭＯＤＳ组内毒素持续不降或继续升高。结论：严重创伤后２４小时内即可形成内毒素血症，推测系来源于胃肠道粘膜屏障损伤所致的毒素易位。这种早期内毒素血症可能参与伤后早期全身炎症反应；

Objective:To investigate the plasma endotoxin levels in early traumatic patients and their significance in early systemic inflammatory response and outcome.Methods:Plasma endotoxin levels and hemodynamic monitoring were performed in 25 major traumatic and postsurgical patients within 24 hours after insults and up to 28 days.The results were analyzed according to different injured severity and outcome of those patients.Twentytwo healthy adults served as normal controls.Results:Sixteen patients survived,9 patients died at the end of study.Of 25 patients,10 underwent hemodynamic monitoring for the first 72 hours and showed hyperhemodynamic responses.Plasma endotoxin levels were significantly elevated within the first 24 hours in most patients,which decreased gradually in survived patients,but increased persistently in patients developing multiple organ dysfunction syndrome and fatal outcome during subsequent periods.Conclusions:These data suggest that endotoxemia,which derived from the gastrointestinal tract,may be involved in the development of systemic inflammatory response early after major trauma.Measurement of plasma endotoxin levels has important values to assess the outcome of patients.