Yu Jiang, Xiao Ying-Bin, Wang Xian-Yuan
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
Chin J Traumatol. 2007 Jun;10(3):131-7.
To evaluate the influence of preoperatively selected gut decontamination (SGD) on intestinally derived endotoxemia(ETM) in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulmonary bypass(CPB).
Thirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i.e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 mg garlicin and 20% Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levels of endotoxin, D-lactate, TNF-alpha and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded.
Aerobic gram-negative bacilli (AGNB) ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group (P less than 0.05). The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB (P less than 0.05). Endotoxin levels of patients in both groups elevated significantly after CPB (P less than 0.05), and endotoxin levels of the patients in SGD group decreased significantly at points of CPB end (P less than 0.01) and 24 h after CPB (P less than 0.05) compared with those in control group. The levels of TNF-alpha and complement 3 were similar in both groups as well as clinical and biochemical markers.
CPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.
评估术前选择性肠道去污（SGD）对风湿性心脏病患者在体外循环（CPB）下行瓣膜置换手术时肠道源性内毒素血症（ETM）的影响。
30例患者随机分为对照组和SGD组。对照组患者进行术前肠道准备，即饮食准备和灌肠。SGD组患者除常规术前肠道准备外，给予100mg妥布霉素、40mg大蒜素和10ml20%乳果糖，每日3次，共3天。采用两组粪便细菌培养鉴定及革兰染色评估肠道菌群种类及其比例。在麻醉诱导、CPB结束、CPB后2小时、CPB后24小时四个时间点测定内毒素、D-乳酸、TNF-α和补体3水平。并记录相关临床生化指标和临床标志物。
与对照组和SGD术前组相比，SGD术后组需氧革兰阴性杆菌（AGNB）比例显著降低（P<0.05）。麻醉诱导和CPB后2小时时间点D-乳酸水平显著降低（P<0.05）。两组患者CPB后内毒素水平均显著升高（P<0.05），与对照组相比，SGD组患者在CPB结束时（P<0.01）和CPB后24小时（P<0.05）内毒素水平显著降低。两组TNF-α和补体3水平以及临床和生化指标相似。
CPB可诱发内毒素血症，而SGD方案是预防内毒素血症的有效方法，但可能不影响炎症介质的激活和临床结局。
