小儿肠道手术后肠道细菌移位及肠道屏障功能变化的临床研究

Clinical research on intestinal bacteria shift and intestinal barrier of pediatric intestinal surgery

目的 探讨小儿肠道手术后肠道细菌移位（BT）及肠道屏障功能变化情况。方法 对61例接受肠道手术的儿童进行手术前后血浆D-乳酸、内毒素（LPS）水平的检测,使用聚合酶链反应（PCR）检测血中细菌DNA判断是否存在BT。结果 61例患儿手术前经细菌培养后提示均无细菌生长,再次检测发现有3例患儿血液细菌培养结果为阳性,其中2例为金黄色葡萄球菌感染、1例为大肠杆菌感染,血培养阳性率为4.91%（3/61）。将血液细菌培养结果和PCR结果比较,发现3例血液细菌培养阳性患儿,在PCR检测中亦为阳性,而另外10例PCR结果阳性患儿,血液细菌培养未见异常。PCR检测阳性率明显高于血液细菌培养检测（χ2=7.19,P＜0.01）。术前61例患儿均无全身多症反应综合征（SIRS）。术后则有22例患儿诊断为SIRS。PCR检测为阳性的患儿中,有11例术后出现SIRS,占84.61%（11/13）。另外,术后有13例患儿出现不同程度的术后感染并发症,感染部位为切口感染5例、肺部感染4例、腹腔感染4例。其中PCR阳性患者中为10例,占76.92%（10/13）。SIRS和感染并发症情况,PCR阳性组与PCR阴性组差异均有统计学意义（均P＜0.01）。对PCR阳性组及阴性组术前血浆D-乳酸、LPS分析发现两组均处于正常水平,两组差异无统计学意义（P＞0.05）。术后24 h,PCR阳性组血浆D-乳酸、LPS出现明显上升,48h后开始下降,与PCR阴性组比较,差异均有统计学意义（均P＜0.01）。结论 小儿肠道手术后肠道屏障损伤和BT关系密切,另外术后SIRS和感染并发症亦和BT有直接联系。

Objective To investigate the clinical correlation of intestinal bacterial translocation（BT） and intestinal barrier of pediatric intestinal surgery,and to observe the relationship between BT and postoperative infection.Methods The plasma D-lactic acid,LPS level of 61 children with intestinal surgery in our hospital were detected before and after surgery.Polymerase chain reaction（PCR） was used to test blood bacterial DNA,in order to judge whether there is BT.Results The PCR results of preoperative children were negative,the PCR positive for 3 cases.According to the PCR results,postoperative systemic inflammatory response syndrome（SIRS） and complications of infection of PCR positive group were obviously higher than those of PCR negative group（P〈0.01）.And plasma D-lactic acid,LPS inspection of PCR positive group were obviously higher than PCR negative group（P〈0.01）.Conclusion Intestinal barrier damage has close relationship with BT in children after intestinal surgery,SIRS and infection complications also has a direct relationship with BT.