早期超声引导腹腔穿刺引流对重症急性胰腺炎病人肠道细菌移位及细胞因子的影响

Effect of early ultrasound-guided abdominal puncture and drainage on intestinal bacterial translocation and cytokines in patients with severe acute pancreatitis

目的:探讨早期行超声引导下腹腔穿刺引流对重症急性胰腺炎(SAP)病人肠道细菌移位及炎症介质的影响。方法:选择SAP病人100例作为研究对象,根据病人发病至入院时间将SAP病人分为观察组(发病至入院≤48 h)与对照组(发病至入院时间>48 h),各50例,2组病人入院均接受超声引导下腹腔穿刺置管引流。比较2组病人肠道菌群数目(乳酸杆菌、双歧杆菌、葡萄球菌和大肠埃希菌)和外周血白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、IL-4及IL-10含量。结果:与对照组比较,治疗后观察组病人致病菌大肠埃希菌菌群数及葡萄球菌菌群数明显减少,有益菌菌群数乳酸杆菌、双歧杆菌菌群数明显增加(P<0.01);与对照组比较,治疗后观察组病人外周血IL-6、TNF-α含量均明显减少,IL-4、IL-10含量均明显增加(P<0.01)。结论:早期超声引导腹腔穿刺引流可以减少SAP病人肠道细菌移位,减轻机体炎症反应。

Objective:To investigate the effects of early ultrasound-guided abdominal puncture and drainage on intestinal bacterial translocation and inflammatory mediators in patients with severe acute pancreatitis(SAP).Methods:One hundred SAP patients were selected as the research objects.According to the time from onset to admission,the SAP patients were divided into the observation group(within 48 hours from onset to admission)and control group(more than 48 hours from onset to admission)(50 cases in each group).Two groups were treated with ultrasound-guided abdominal puncture and drainage.The number of intestinal flora(including lactobacilli,bifidobacteria,staphylococci and Escherichia coli)and serum levels of interleukin(IL)-6,tumor necrosis factor-α(TNF-α),IL-4 and IL-10 were compared between two groups.Results:Compared with the control group,the number of pathogenic Escherichia coli and Staphylococci were significantly reduced,and the number of beneficial bacteria(lactobacilli and bifidobacteriza)significantly increased in the observation group after treatment(P<0.01).Compared with the control group,the serum levels of IL-6 and TNF-αsignificantly decreased,and the serum levels of IL-4 and IL-10 significantly increased in the observation group after treatment(P<0.01).Conclusions:The early ultrasound-guided abdominal puncture and drainage can reduce the intestinal bacterial translocation and inflammatory response in SAP patients.