Peitzman A B, Udekwu A O, Ochoa J, Smith S
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15261.
J Trauma. 1991 Aug;31(8):1083-6; discussion 1086-7.
Sepsis and multiple system organ failure (MSOF) are major causes of morbidity and mortality in trauma patients. Bacterial translocation induced by hypotension, endotoxemia, or burns is a reproducible phenomenon in the laboratory. The incidence of bacterial translocation to mesenteric lymph nodes (MLNs) in 29 critically ill patients was evaluated to determine its relationship to subsequent sepsis and MSOF. Bacterial translocation was documented in 3 of 4 patients who underwent laparotomy for gastrointestinal (GI) disease. No trauma patient (25 patients), even at second exploration 3-5 days after injury, had a positive MLN culture. Five patients died; 4 trauma patients, one with GI disease. Forty percent of the trauma patients had major complications, predominantly pulmonary infections with gram-negative bacteria. However, infectious complications and outcome were not related to MLN culture results. The classical progression of bacteria from the gut to the bloodstream via the MLNs may require time and gut mucosal injury. The data suggest that bacterial translocation to the MLNs is not a common occurrence in acutely injured trauma patients.
脓毒症和多系统器官功能衰竭（MSOF）是创伤患者发病和死亡的主要原因。由低血压、内毒素血症或烧伤引起的细菌移位在实验室中是一种可重现的现象。评估了29例危重症患者肠系膜淋巴结（MLN）细菌移位的发生率，以确定其与随后的脓毒症和MSOF的关系。4例因胃肠道（GI）疾病接受剖腹手术的患者中有3例记录到细菌移位。没有创伤患者（25例），即使在受伤后3 - 5天进行二次探查时，MLN培养结果也呈阳性。5例患者死亡；4例创伤患者，1例患有GI疾病。40%的创伤患者有严重并发症，主要是革兰氏阴性菌引起的肺部感染。然而，感染性并发症和预后与MLN培养结果无关。细菌经MLN从肠道向血液的经典进展可能需要时间和肠道黏膜损伤。数据表明，在急性受伤的创伤患者中，细菌移位至MLN并不常见。
