术后外周血内毒素水平与术后并发症及创伤程度的关系

The correlations between peripheral blood endotoxin levels and postoperative complications/severity of trauma in surgical patients

目的 观察手术创伤与内毒素移位的关系 ,分析外周血内毒素水平与术后并发症、创伤程度及全身炎症反应综合征 (SIRS)的关系。 方法 5 0例健康志愿者及 111例外科手术患者参加本研究。分别于术前 1天、术后 3天、6天采外周血测内毒素水平 ,统计术后并发症、全身炎症反应综合征 (SIRS)的发生情况。 结果 111例患者中术后 3天外周血内毒素水平 [(0 .0 34± 0 .0 0 7)EU]较术前 [(0 .0 2 5± 0 .0 0 5 )EU]明显增高 (P =0 .0 0 0 ) ,术后第 6天 [(0 .0 32± 0 .0 0 9)EU ]较术后 3天[(0 .0 34± 0 .0 0 7)EU]明显降低 (P =0 .0 0 4) ,并有恢复到术前水平的趋势。术后 3天SIRS组外周血内毒素水平 [(0 .0 39± 0 .0 0 7)EU]明显高于非SIRS组 [(0 .0 32± 0 .0 0 6 )EU],二者差异有显著性意义(P =0 .0 0 0 )。出现并发症组术后外周血内毒素水平 [(0 .0 47± 0 .0 0 7)EU ]较无并发症组 [(0 .0 34±0 .0 0 7)EU]明显增高 (P =0 .0 0 0 )。 结论 外科大中型手术可致肠道内毒素移位 ,表现在外周血内毒素水平升高。外周血内毒素水平增高与手术创伤程度、术后SIRS及术后并发症相关。

Objective To observe the endotoxin levels in peripheral blood in both preoperative and postoperative samples and analyze the relationship between endotoxin levels and complications/severity of trauma. Methods 50 healthy volunteers and 111 consecutive patients admitted to the Department of General Surgery were enrolled in the study.Informed consents were obtained in all patients.Serial plasma endotoxin determinations were made using chromogenic limulus amebocyte lysate assay.The correlations between endotoxin levels in peripheral blood and postoperative complications/severity of trauma were analyzed by statistic software SPSS. Results Endotoxin levels on postoperative day 3 [(0.034±0.007)EU] significantly elevated than preoperative samples [(0.025±0.005)EU]( P =0.000).Endotoxin levels on postoperative day 3 were positively correlated with postoperative complications( r=0.607,P =0.000),APACHE Ⅱ scores ( r=0.584,P=0.000 ),and POSSUM scores ( r=0.830,P =0.000).Endotoxin levels on postoperative day 3 in SIRS group [(0.039±0.007)EU] were significantly higher than that of the none SIRS group [(0.032±0.006)EU]( P =0.000). Conclusions Endotoxin levels in peripheral blood positively correlated with postoperative complications,severity of trauma,and systemic inflammatory response syndrome (SIRS).Endotoxin translocation could be induced by major and medium surgical operation.