肠外瘘患者消化液中细菌与酶含量在体外变化的观察

Change of bacteria and enzymes in the drainage fluid in patients with intestinal fistulas

目的探讨肠外瘘患者消化液中细菌与酶含量在体外的变化。方法收集1998年7月至2008年1月我院16例高位肠外瘘患者瘘出的新鲜消化液，分别在0、2、4h测定引流液中细菌数量、淀粉酶和脂肪酶的含量。将瘘出的消化液及时回输入远端肠道，同时在肠液回输的0、7、14d测定患者血清中自蛋白、纤维连接蛋白、转铁蛋白、前白蛋白水平。结果消化液中细菌数量4h内无增加（F（0.2）=18812．50，P〉0．05；F（0.4）=387625．00，P〉0．05）。消化液中淀粉酶含量（F（0.2）=190．60，P〉0．05；F（0．4）：631．75，P〉0．05）和脂肪酶含量（F（0．2）=204．10，P〉0．05；F（0，4）：1080．05，P〉0．05）4h内无变化。肠液回输后患者血清中纤维连接蛋白[0、7、14d分别为（152．80±16．50）、（167．27±20．54）、（227．05±45．36）mg／L；F（0．14）=74．24，P〈0．01；F（7.14）=59．78，P〈0．01]、转铁蛋白[0、7、14d分另4为（2．16±0．52）、（2．23±0．48）、（2．62±0．41）g／L；F（0．14）=0．46，P〈0．01；F（7．14）=0．39，P〈0．05]、前白蛋白[0、7、14d分别为（177．74±45．14）、（194．04±49．33）、（232．11±79．57）mg／L；F（0,14）=54．37，P〈0．05]水平显著增加。结论肠外瘘患者消化液中细菌和酶含量在体外4h内无变化，肠液回输是安全有效的。

Objective To investigate the amount of bacteria and the expression of amylase and lipases in the drainage fluid in patients with intestinal fistulas with time courses. Methods The samples were collected from 16 patients with high intestinal fistulas from July 1998 to January 2008. The amounts of bacteria from the drainage fluid were measured 0, 2 and 4 hours after taking out from the patients. At the respective time points, the intestinal juices were also collected to measure the amylase and lipase expressions. After reinfusion of suceus entericus, the levels of albumin, prealbumin, transferring, and fibronectin were measured at 0, 7, and 14 days. Results There was no significant increase of bacteria in the drainage fluid within 4 hours （ F（0,2） = 18 812. 50, P 〉 0. 05 ; F（0,4） = 387 625.00, P 〉 0. 05 ）. and there was no change in the expressions of amylase （ F（0,2） = 190. 60, P 〉 0. 05 ; F（0,4） = 631.75, P 〉 0. 05 ） and lipase within 4 hours （ F（0,2） = 204. 10, P 〉 0. 05 ; F（0,4） = 1080. 05, P 〉 0.05）. After succus entericus reinfusion, the fibroneetin （F（0,14） = 74. 24, P 〈 0.01 ; F（7,14） = 59. 78, P 〈 0.01 ）, transferring （F（0,14） = 0. 46, P 〈 0. 01 ; F（7,14） = 0. 39, P 〈 0. 05 ）, and prealbumin （F（0,4） = 54. 37, P 〈 0.05 ） were increased significantly. Conclusions Bacteria and enzymes do not increase in the drainage fluid within 4 hours in patients with intestinal fistulas. Therefore, it is safe and effective to reinfuse succus entericus.