选择性肠道脱污染预防急性坏死性胰腺炎继发感染的实验研究

目的　通过急性坏死性胰腺炎(ANP)动物模型，探讨选择性消化道脱污染(SDD)预防胰腺继发感染的作用。方法　Wistar大鼠60只，向总胆胰管逆行输入人工胆汁复制ANP模型，随机设立正常对照组、假手术对照组、ANP组和SDD治疗组，观察胰肠组织学、胰淀粉酶、肠道菌群、脏器细菌移位率和死亡率的变化。结果　SDD使ANP动物胰腺和小肠粘膜病理改变减轻，胰淀粉酶水平下降(P＜0.05)，并使ANP时肠道菌群的紊乱状态得以恢复，肠粘膜和肠内容物双歧杆菌/大肠杆菌比值(B/E)分别由-0.37±0.72升至1.73±1.23(P＜0.01)和由0.88±0.77升至无穷大。SDD组72h脏器细菌移位率由59.5%降至33.3%(P＜0.05)，72h死亡率由58.8%降至14.3%(P=0.005)。结论　SDD通过减轻肠道菌群紊乱状态，减少细菌移位，有利于预防ANP继发感染。

An experimental study on selective decontamination of digestive tract in prevention of infections secondary to acute necrotizing pancreatitis

Objective To investigate the role of selective decontamination of the digestive tract (SDD) in prevention of bacterial infections secondary to acute necrotizing pancreatitis (ANP). Methods A total of 60 rats were employed to establish the model of ANP with retrograde infusion of artificial bile into the main pancreatic duct. Then animals were randomized into the normal control group (n =6), sham operated group (n = 14) and SDD-treated group (polymycinE, tobramycin and nystatin mixture were used). Visceral pathological changes, serum levels of amylase, intestinal flora, incidence of bacterial translocation to organs and mortality were determined 72 h after the operation in all the 3 groups. Results In SDD-treated group, damages in the pancreas were remarkably attenuated and serum level of amylase significantly decreased. At the 72nd h after treatment, the rate of bacterial translocation to other organs and mortality markedly decreased to 33.3% and 14.3% from the original 59.5% and 58.8%, respectively (P<0.05). Conclusions SDD can prevent infections secondary to ANP through controlling bacterial disturbance in the digestive tract and reduce bacterial translocation.