Department of Gastrointestinal Surgery, Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
World J Emerg Med. 2010;1(3):205-8.
The gut is capable of inducing multiple organ dysfunction syndrome (MODS). In the diagnosis and treatment of critical ill patients, doctors should pay particular attention to the protection or recovery of intestinal barrier function. However, no reliable diagnostic criteria are available clinically. This study aimed to assess the changes of intestinal mucosal barrier function in surgically critical ill patients as well as their significance.
Thirty-eight surgically critical ill patients were enrolled as a study group (APACHE II>8 scores), and 15 non-critical ill patients without intestinal dysfunction were selected as a control group (APACHE II<6). General information, symptoms, physical signs, and APACHE II scores of the patients were recorded. The patients in the study group were subdivided into an intestinal dysfunction group (n=26) and a non-intestinal dysfunction group (n=12). Three ml venous blood was collected from the control group on admission and the same volume of plasma was collected from the study group both on admission and in the period of recovery. The plasma concentrations of endotoxin, diamine oxidase (DAO), D-lactate, and intestinal fatty-acid binding protein (iFABP) were detected respectively. The data collected were analyzed by the SPSS 17.0 software for Windows.
The levels of variables were significantly higher in the study group than in the control group (P<0.01). They were higher in the intestinal dysfunction group than in the non-intestinal dysfunction group (DAO P<0.05, endotoxin, D-lactate, iFABP P<0.01). In the non-intestinal dysfunction group compared with the control group, the level of endotoxin was not significant (P>0.05), but the levels of DAO, D-lactate and iFABP were statistically significant (P<0.05). The levels of variables in acute stage were higher than those in recovery stage (P<0.01). The death group showed higher levels of variables than the survival group (endotoxin and D-lactate P<0.01, DAO and iFABP P<0.05).
The plasma concentrations of endotoxin, DAO, D-lactate, and intestinal fatty-acid binding protein (iFABP) could reflect a better function of the intestinal mucosa barrier in surgically critical ill patients.
肠道能够引发多器官功能障碍综合征（MODS）。在危重症患者的诊断和治疗中，医生应特别注意保护或恢复肠屏障功能。然而，临床上没有可靠的诊断标准。本研究旨在评估手术危重患者肠黏膜屏障功能的变化及其意义。
纳入 38 例手术危重患者作为研究组（APACHE II>8 分），选择 15 例无肠功能障碍的非危重患者作为对照组（APACHE II<6 分）。记录患者的一般资料、症状、体征和 APACHE II 评分。研究组患者分为肠功能障碍组（n=26）和非肠功能障碍组（n=12）。对照组入院时采集静脉血 3ml，研究组入院时及恢复期各采集静脉血 3ml，检测血浆内毒素、二胺氧化酶（DAO）、D-乳酸和肠脂肪酸结合蛋白（iFABP）浓度。采用 Windows 版 SPSS 17.0 软件对收集的数据进行分析。
研究组各变量水平明显高于对照组（P<0.01）。肠功能障碍组明显高于非肠功能障碍组（DAO P<0.05，内毒素、D-乳酸、iFABP P<0.01）。与对照组比较，非肠功能障碍组内毒素水平无统计学意义（P>0.05），DAO、D-乳酸和 iFABP 水平有统计学意义（P<0.05）。急性期各变量水平高于恢复期（P<0.01）。死亡组各变量水平高于存活组（内毒素和 D-乳酸 P<0.01，DAO 和 iFABP P<0.05）。
内毒素、DAO、D-乳酸和肠脂肪酸结合蛋白（iFABP）的血浆浓度可反映手术危重患者肠黏膜屏障功能的改善。
