Ziegler T R, Smith R J, O'Dwyer S T, Demling R H, Wilmore D W
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02215.
Arch Surg. 1988 Nov;123(11):1313-9. doi: 10.1001/archsurg.1988.01400350027003.
Thermal injury may be associated with disruption of normal gut barrier integrity. To test this hypothesis, we assessed intestinal permeability with the nonmetabolizable, poorly absorbed disaccharide lactulose, which is efficiently excluded by the normal intestinal mucosa. Permeability studies were performed in 15 burned patients (aged 18 to 67 years; mean burn size, 40%) and 11 healthy controls. Lactulose, 10 g, was administered enterally, together with 5 g of mannitol as a control, and urinary excretion rates were determined. Lactulose excretion and the lactulose/mannitol excretion ratio increased threefold (160 +/- 30 vs 57 +/- 7 mumol and 0.113 +/- 0.033 vs 0.035 +/- 0.005) in the infected patients (sepsis score, 10 +/- 2; burn size, 38% +/- 6%). In contrast, noninfected burn patients (sepsis score, 0) had permeability values similar to those of controls (66 +/- 10 mumol and 0.036 +/- 0.007). Permeability increased as the severity of infection increased. Infection in burn patients is associated with increased bowel permeability. The intestine may be a primary source of sepsis. Alternatively, the systemic response to infection may alter gut barrier function, which could facilitate translocation of bacteria and absorption of endotoxin.
热损伤可能与正常肠道屏障完整性的破坏有关。为了验证这一假设，我们使用不可代谢、吸收不良的双糖乳果糖评估肠道通透性，正常肠黏膜可有效阻止其通过。对15例烧伤患者（年龄18至67岁；平均烧伤面积40%）和11名健康对照者进行了通透性研究。口服给予10 g乳果糖，并给予5 g甘露醇作为对照，测定尿排泄率。感染患者（脓毒症评分10±2；烧伤面积38%±6%）的乳果糖排泄及乳果糖/甘露醇排泄率增加了两倍（分别为160±30 vs 57±7 μmol和0.113±0.033 vs 0.035±0.005）。相比之下，未感染的烧伤患者（脓毒症评分0）的通透性值与对照者相似（66±10 μmol和0.036±0.007）。通透性随感染严重程度的增加而升高。烧伤患者的感染与肠道通透性增加有关。肠道可能是脓毒症的主要来源。或者，机体对感染的反应可能会改变肠道屏障功能，这可能会促进细菌移位和内毒素吸收。
