选择性肠道去污对非感染性创伤患者合并血清降钙素原升高的治疗作用

Effect of selective decontamination of digestive tract for non-infective trauma patients with procalcitonin elevation

目的探讨选择性肠道去污治疗对非感染性创伤合并血清降钙素原升高患者的影响。方法将80例伴有血清降钙素原升高的非感染性创伤患者分为实验组和对照组,每组40例。其中实验组患者给予选择性肠道去污治疗,对照组给予生理盐水对照处理。连续监测所有患者血清降钙素原及内毒素水平的变化。并于治疗14 d后观察有无急性肾损伤发生。结果实验组患者血清降钙素原治疗后第7、9、11、13天分别为（1.29±0.26）、（0.89±0.15）、（0.56±0.16）、（0.50±0.18）μg/L,内毒素水平分别为（82±12）、（53±8）、（47±8）、（34±6）EU/L,对照组患者治疗后第7、9、11、13天分别血清降钙素原为（3.90±0.64）、（3.52±0.45）、（3.98±0.78）、（3.56±0.08）μg/L,内毒素水平分别为（101±18）、（113±17）、（108±13）、（96±16）EU/L,实验组患者血清降钙素原（t=23.906、35.279、27.236、36.406,P均〈0.05）及内毒素均明显低于对照组患者（t=5.705、20.407、24.989、22.901,P均〈0.05）。同时,对照组发生急性肾损伤风险高于实验组（27/40 vs.15/40,χ^2=7.218,P〈0.05）。结论非感染性创伤合并降钙素原升高的患者为肠源性感染,选择性肠道去污治疗可明显降低血清降钙素原及内毒素水平,从而减小后续治疗中发生急性肾损伤的风险。

Objective To investigate the effect of selective decontamination of the digestive tract on the non-infective trauma patients with procalcitonin elevation. Methods A total of80 non-infective trauma patients with procalcitonin elevation were randomly divided into the experiment group and control group, 40 cases in each group. The patients in the experiment group were treated with selective intestinal decontamination, and patients in the control group received normal saline at the same time. The levels of serum procalcitonin and endotoxin were monitored continuously. And the acute kidney injury（AKI） were assessed in the two groups. Results At 7,9, 11, 13 d after treatment, the procalcitonin levels and the endotoxin levels were significantly lower in the experiment group than those in the control group（1.29 ± 0.26 vs. 3.90 ± 0.64, 0.89 ± 0.15 vs. 3.52 ±0.45, 0.56 ± 0.16 vs. 3.98 ± 0.78, 0.50 ± 0.18 vs. 3.56 ± 0.08 μg / L, t = 23.906, 35.279, 27.236,36.406, all P〈0.05; and 82 ± 12 vs. 101 ± 18, 53 ± 8 vs. 113 ± 17, 47 ± 8 vs. 108 ± 13, 34 ± 6 vs.96 ± 16 EU / L, t = 5.705, 20.407, 24.989, 22.901, all P〈0.05）. Meanwhile, the rate of AKI in the control group were higher than those in the experiment group（27 / 40 vs. 15 / 40, χ2= 7.218,P〈0.05）. Conclusion Our research further confirmed that the reason of non-infective trauma patients with procalcitonin elevation is belong to intestinal infection, and selective decontamination of digestive tract can be significantly reduced the level of procalcitonin and endotoxin, and thereby reduce the risk of AKI in follow-up treatment.