心脏手术后视幻觉发生与肠道菌群变化的研究

Occurrence of pseudopsia and changes in intestinal microflora after cardiac surgery

目的探究心脏术后患者视幻觉症状发生情况及体内肠道菌群变化。方法选取2020年1月-2021年1月中国科学院大学宁波华美医院接受择期体外循环心脏手术的成年患者21例作为研究对象。分别在术前、术后第1次或第2次排便、术后6~8 d进行微生物分析和粪便短链脂肪酸(SCFAs)浓度测定。采用实时荧光定量PCR法检测肠道菌群组成,高效液相色谱检测SCFAs。术后1周进行视幻觉评价。结果 21例患者中,视幻觉3例。与术前相比,术后第1和第2份粪便样本的微生物总数显著降低(P<0.05)。在专性厌氧菌中,第一次术后粪便样本中的球形梭菌数量、柔嫩梭菌数量显著低于术前样本。兼性厌氧菌中,术后第1次和第2次标本的乳酸杆菌总数均显著降低。植物乳杆菌数量在第1次术后粪便样本中较低。L.sakei数量在第2次术后标本中明显下降。术后第1次粪便样本中肠杆菌科的数量明显高于术前样本。与术前相比,术后第1次粪便样本中的肠球菌数量显著升高。术后第2次粪便标本中葡萄球菌数量明显高于术前标本。术后视幻觉组葡萄球菌数量明显高于非视幻觉组,第2次术后粪便样本中术后视幻觉组葡萄球菌数量也明显高于非幻视觉组。视幻觉组的假单胞菌数量明显高于非视幻觉组和术后第2次粪便样本。术后第1次粪便标本中,视幻觉组肠杆菌数量高于非视幻觉组。视幻觉组术后第一次粪便样本中总SCFAs浓度显著低于非视幻觉组。以上差异均具有统计学意义(P<0.05)。结论心脏手术后视幻觉的发生与肠道菌群变化存在一定联系,表现为肠道内肠杆菌科和肠球菌属数量增多,乳杆菌数量降低,同时还伴随着SCFAs浓度的降低。

Objective To explore the occurrence of pseudopsia symptoms and the changes in intestinal bacteria in vivo after cardiac surgery. Methods Twenty-one adult patients undergoing elective cardiopulmonary bypass cardiac surgery at our hospital from January, 2020 to January 2021 were selected as the subjects. Microbial analysis and fecal short-chain fatty acids(SCFAs) detection were performed before, at the first or second post-operative defecation, and Day 6 to 8 after surgery, respectively. Intestinal floral composition was determined with real-time PCR and SCFAs were detected using HPLC. Evaluation of pseudopsia were performed 1 week after surgery. Results Of the 21 patients, 3 had pseudopsia. The total count of microbes significantly reduced in the first and second post-operative stool samples compared to that before surgery(P<0.05). In obligate anaerobes, the counts of Clostridium coccoides group and Clostridium leptum subgroup were significantly lower in the first postoperative stool samples compared with the preoperative samples. In facultative anaerobes, the total count of Lactobacillus significantly reduced in both the first and second postoperative anaerobic specimens. The count of Lactobacillus planta subgroups was lower in post-operative stool samples. The count of L. sakei subgroup decreased significantly in the second post-operative specimens. The count of Enterobacteriaceae was significantly higher in the first post-operative sample compared with the preoperative samples. The count of Enterococci was significantly higher in the first post-operative samples compared to preoperative samples. The count of Staphylococcus was significantly higher in the second postoperative stool specimen compared with the preoperative specimen. The count of Staphylococci was significantly higher in the postoperative pseudopsia group than in the non-pseudopsia group, and was significantly higher in the second postoperative stool sample than in the non-pseudopsia group. Pseudomonas count was significantly higher in the pseudopsia group than in the non-pseudopsia group and in the second postoperative stool samples. In the first postoperative stool specimen, the count of Enterobacteriaceae was higher in the pseudopsia group compared with the non-pseudopsia group. The total fecal SCFAs in the first postoperative fecal samples in pseudopsia group were significantly lower than in the non-pseudopsia group. The differences were all statistically significant(P<0.05). Conclusion The occurrence of pseudopsia after cardiac surgery is somewhat linked with changes in intestinal flora, manifested by the increase of Enterobacteriaceae and Enterococci in vivo. The increased number of Lactobacillus was accompanied by a decreased concentration of SCFAs.