急性感染性腹膜炎患者外周血内毒素水平与急性肺损伤的相关性分析

THE CORRELATIONS BETWEEN PLASM LEVELS OF ENDOTOXIN AND ACUTE LUNG INJURY IN PATIENTS WITH ACUTE INFECTIOUS PERITONITIS AND ANALYZE THE RELATIONSHIP

目的观察急性感染性腹膜炎手术患者外周血内毒素水平与急性肺损伤(ALI)发生的相关性分析。方法选取我院2008年12月～2010年6月诊断感染性腹膜炎入住我院重症医学科(ICU)患者32例,根据是否合并肺损伤分为急性肺损伤组(ALI)和无急性肺损伤组(NALI),每组16例。分别检测术前1小时、术后第0、2、5、14天外周血内毒素水平(ETX)、IL-6、氧合指数(PaO2/FiO2)、肺顺应性(Cs)等指标。结果感染性腹膜炎患者术前外周血内毒素水平与肺损伤的发生呈明显相关性,术前1 h内素素水平的升高与术后第0、2天IL-6分泌的异常增加呈明显正相关(P<0.01);术后第2、5天IL-6的升高与ALI的程度以及MOF的发生呈显著正相关。经术中及术后抗感染、引流、腹腔冲洗等去除肠源性感染诱因等综合治疗,随内毒素水平的下降,IL-6分泌逐渐下调,ALI程度逐渐减轻。结论内毒素血症是感染性腹膜炎诱发ALI的重要因素之一。及早选择合适的治疗措施,防止或减轻内毒素水平的增高,减少肠道内毒素的移位、进而减少IL-6失控性分泌,则在阻止内毒素性急性肺损伤、MODS的发生可能起到重要的防治作用。

Object Observe the correlations between plasm levels of endotoxin and acute lung injury in surgery patients with acute infectious peritonitis and analyze the relationship.Method Select 32 patients with acute infectious peritonitis during December 2008 and June 2010 in ICU of our hospital and divide them into two groups,i.e.ALI group and NALI group.Measure the parameters such as plasm levels of endotoxin,IL-6,OI and Cs,respectively at 1 hour before the surgery and 0,2,5,14 days after the surgery.Results Before the surgery,the plasm levels of endotoxin in patients with acute infectious peritonitis are obviously related with the occurrence of acute lung injury.The rise of plasm levels of endotoxin at 1 hour before the surgery is positively related with the rise of levels of IL-6 at 0 and 2 days after the surgery（P0.01）.The rise 0f IL-6 at 0 and 2 days after the surgery is positively related with ALI level and occurrence of MOF.Through the comprehensive treatment such as anti-interference,drainage,and abdomen flushing during and after the surgery to wipe off interference effect from gut,the plasm levels of endotoxin will decrease,the mis-balance of IL-6 will correct and ALI level gradually decrease.Conclusion The endotoxin is one of the important factors for acute infectious peritonitis cause to happen ALI.Selecting suitable treatment to prevent and reduce the plasm level of endotoxin rise,reduce endotoxin translocation in enteric canal and reduce mis-balance of IL-6,will probably play an important treatment effect on preventing endotoxin acute lung injury and MODS occurrence.