Ingoldby C J, McPherson G A, Blumgart L H
Am J Surg. 1984 Jun;147(6):766-71. doi: 10.1016/0002-9610(84)90197-1.
A clinical trial was undertaken to study endotoxemia in 14 patients with obstructive jaundice given the antiendotoxin polymyxin B, 13 patients with obstructive jaundice who were not given the antiendotoxin , and 13 nonjaundiced control patients undergoing comparable surgery. Endotoxins were detected by the limulus assay. Endotoxemia did not occur in the nonjaundiced patients but was common before (68 percent), during (70 percent), and after (81 percent) surgery in the jaundice patients. Thirty-six percent of the jaundiced patients had postoperative oliguria. Endotoxemia before surgery was associated with death after surgery, all deaths occurring in patients who were endotoxemic before operation (p less than 0.05). Polymyxin B infusion had no effect on endotoxemia or outcome. Measurement of indicators of fibrinolysis, soluble fibrin, and fibrin degradation products showed no prognostic significance. We conclude that preoperative endotoxemia is an important predictor of outcome in patients who undergo surgery for jaundice.
开展了一项临床试验，研究14例接受抗内毒素多粘菌素B治疗的梗阻性黄疸患者、13例未接受抗内毒素治疗的梗阻性黄疸患者以及13例接受类似手术的非黄疸对照患者的内毒素血症情况。采用鲎试剂法检测内毒素。非黄疸患者未发生内毒素血症，但黄疸患者术前（68%）、术中（70%）及术后（81%）内毒素血症常见。36%的黄疸患者术后出现少尿。术前内毒素血症与术后死亡相关，所有死亡均发生在术前存在内毒素血症的患者中（P<0.05）。输注多粘菌素B对内毒素血症或预后无影响。纤维蛋白溶解指标、可溶性纤维蛋白及纤维蛋白降解产物的检测无预后意义。我们得出结论，术前内毒素血症是接受黄疸手术患者预后的重要预测指标。
