胃癌根治手术后行抗菌药物治疗对患者肠道细菌移位及肠黏膜屏障功能的影响

Effect of antibiotic treatment after radical gastrectomy on intestinal bacterial translocation and intestinal mucosal barrier function in patients with gastric cancer

目的研究胃癌根治手术后抗菌药物治疗对患者肠道细菌移位和肠黏膜屏障功能的影响。方法回顾性分析2020年6月至2022年6月100例胃癌根治术患者资料,根据是否使用抗菌药物分为实验组(n=50例,抗菌药物治疗)和自然恢复组(n=50例,无抗菌药物治疗)。采用SPSS22.0统计软件处理数据,肠道菌群数目、肠黏膜通透性指标、应激水平、血浆D-乳酸、二胺氧化酶(DAO)水平、血浆谷氨酰胺(Gln)含量以及胃肠动力相关指标等计量资料采用(x±s)表示,采用独立样本t检验;并发症发生情况及血中细菌DNA检测种类数目等计数资料采用χ^(2)检验。P<0.05为差异有统计学意义。结果两组患者血液中细菌DNA、肠道菌群数目、肠黏膜的通透性、应激水平、血浆D-乳酸、DAO水平、血浆Gln含量以及肠动力间有显著差异(P<0.05)。实验组血液细菌培养阳性数目为0,自然恢复组为14.0%;实验组患者术后肠道菌群数目情况优于自然恢复组(P<0.05),且乳果糖/甘露醇(L/M)值和血浆内毒素(LPS)值显著增加;自然恢复组的白细胞总数(WBC)、C反应蛋白(CRP)和降钙素原(PCT)水平较实验组高(P<0.05)。另外,实验组排气时间、腹泻时间、因腹泻用药次数均少于自然恢复组(P<0.05)。实验组并发症总发生率(10.0%)低于自然恢复组(16.0%),但差异无统计学意义(P>0.05)。结论当肠黏膜受损时,细菌移位会导致肠道感染的发生,而腹部外科手术后早期会引发肠道细菌移位的发生,使用抗菌药物可以减少细菌感染,改善肠道黏膜通透性,促进机体的恢复。

Objective To study the effects of antibiotic treatment on intestinal bacterial translocation and intestinal mucosal barrier function in patients after radical gastrectomy for gastric cancer.Methods A retrospective analysis was conducted on the data of 100 patients undergoing radical gastrectomy for gastric cancer from June 2020 to June 2022.They were divided into an experimental group(50 cases treated with antibiotics)and a natural recovery group(50 cases treated without antibiotics)based on whether antibiotics were used.SPSS 22.0 statistical software was used to process the data.Quantitative data such as the number of gut microbiota,intestinal mucosal permeability indicators,stress levels,plasma D-lactate,diamine oxidase(DAO)levels,plasma glutamine(Gln)content,and gastrointestinal motility related indicators were expressed using(x±s)and independent sample t tests were used.The occurrence of complications and the number of bacterial DNA testing types in the blood were counted usingχ^(2) analysis showed a statistically significant difference of P<0.05.Results There were significant differences between the two groups in blood bacterial DNA,the number of Gut microbiota,intestinal mucosal permeability,stress level,plasma D-lactic acid,DAO level,plasma Gln content and intestinal motility(P<0.05).The positive number of blood bacterial cultures in the test group was 0,while in the natural recovery group was 14.0%;The number of Gut microbiota in the test group was better than that in the natural recovery group(P<0.05),and the Lactulose/Mannitol(L/M)value and plasma endotoxin(LPS)value were significantly increased.the total count of white blood cell(WBC),C-reactive protein(CRP)and Calcitonin(PCT)in the natural recovery group were higher than those in the test group(P<0.05).In addition,the exhaust time,diarrhea time,and medication frequency due to diarrhea in the experimental group were all lower than those in the natural recovery group(P<0.05).The total incidence of complications in the test group(10.0%)was lower than that in the natural recovery group(16.0%),but the difference was not statistically significant(P>0.05).Conclusion When the intestinal mucosa is damaged,bacterial translocation can lead to the occurrence of intestinal infection,and early postoperative abdominal surgery can lead to the occurrence of intestinal bacterial translocation.The use of antibiotics can reduce bacterial infection,improve intestinal mucosal permeability,and promote the recovery of the body.