重症急性胰腺炎患者肠屏障功能障碍与血流感染之间的关系研究

Study on correlation between intestinal barrier dysfunction in patients with severe acute pancreatitis and bloodstream infections

目的探讨重症急性胰腺炎患者肠屏障功能障碍与血流感染之间的关系,以降低感染率。方法选取2010年1月-2012年1月入住ICU重症急性胰腺炎患者72例,根据静脉血生化检验结果分为血流感染组26例和非血流感染组46例,对两组患者进行APACHEⅡ评分,并于入院当天及入院后的第1、3、7天测定尿乳果糖与甘露醇的比值(L/M)、肾功能及内毒素(ET),记录受累器官数、28d病死率等。结果血流感染组患者住ICU的时间及28d的病死率显著增加,尿中尿乳果糖与甘露醇的比值以及血ET水平逐渐升高,与非血流感染组患者比较,差异均有统计学意义;血流感染组患者累及受损器官数随着时间的推移逐渐增多,高于非血流感染组患者,差异有统计学意义;两组患者尿中L/M比值与其血中ET水平呈正相关。结论重症急性胰腺炎患者会出现肠黏膜通透性增加,肠屏障功能障碍,血中的内毒素水平明显增加,细菌随着血液播散,病死率增加,病程中控制血流感染是降低病死率的重要手段。

OBJECTIVE To explore the relationship between the bloodstream infections and the intestinal barrier dysfunction in patients with severe acute pancreatitis so as to reduce the infection rate.METHODS A total of 72patients with severe acute pancreatitis who were hospitalized the ICU from Jan 2010to Jan 2012were enrolled in the study,then the subjects were divided into the bloodstream infection group with 26cases and the non-bloodstream infection group according to the results of biochemical examination of venous blood,the patients＇ scores on the acute physiology and chronic heart evaluationⅡ（APACHEⅡ）were calculated,the ratio of lactulose and mannitol（L/M）,renal function,and level of endotoxin were determined at the time of admission to the hospital and then on the first,third,and seventh day of enrollment in the hospital,the number of involved organs and 28-day mortality rate,were recorded.RESULTS The length of ICU stay of the bloodstream infection group was significantly prolonged,the 28-day mortality rate was increased,the ratio of lactulose and mannitol and the serum edotoxin level were elevated,as compared with the patients without bloodstream infections,the differences were significant.The number of the organs involved was increased with the time,however,the number of the organs involved of the patients without bloodstream infections were significantly less than that of the patients without infections;the ratio of lactulose and mannitol was positively correlated with the level of serum endotoxin.CONCLUSIONThe patients with severe acute pancreatitis are complicated with the increase of permeability of intestinal mucosa,intestinal barrier dysfunction,and significant increase of the serum edotoxin level,the spread of bacteria through blood leads to the increase of mortality rate.It is the key to control the bloodstream infections during the disease course so as to reduce the mortality rate.