选择性肠道去污和盲肠造口/结肠灌洗对猪急性重症胰腺炎后肠源性细菌/内毒素移位的影响

目的:观察选择性肠道去污(SDD)和盲肠造口、结肠灌洗对猪急性重症胰腺炎(ASP)后肠源性细菌/内毒素移位的影响。方法:选健康长白种猪23头,体重16-22kg,雌雄不限,随机分为4组:组Ⅰ:假手术对照组(n=5);组Ⅱ:ASP对照组(n=6);组Ⅲ:ASP+SDD预防组(n=6);组Ⅳ:ASP+盲肠造口、结肠灌洗组(n=6)。在麻醉状态下,进腹向胰总管注入1mL/kgBW5%牛磺胆酸钠混合液[内含(8-10)×10⁶BAEE单位胰蛋白酶/L,pH7.6]诱导ASP。以0.9%NaCl磷酸盐缓冲液取代5%牛磺胆酸钠混合液即为假手术对照组。分别于ASP诱导前30min、诱导后6h、24h、48h、72h采集腔静脉血作内毒素测定(鲎试剂法)。ASP后72h,采集门、腔静脉血及大小肠系膜淋巴结、肺组织、肺门淋巴结、胰腺组织作系列细菌定量培养和细菌鉴定。结果:预防性SDD不仅可非常显著降低大便培养中肠杆菌数(P<0.01),而且使血浆内毒素水平明显下降,血和组织器官中移位细菌数量明显降低。盲肠造口、结肠灌洗亦可有效地降低血浆内毒素水平及组织器官中移位细菌数量。结论:预防性SDD或盲肠造口/结肠灌洗均可有效地减少胰腺炎性肠道细菌/内毒素移位,尤其后者具有重要的临床指导意义。

Influence of SDD and caecostomy/colonic irrigation on gut endotoxin/bacteria translocation following acute severe pancreatitis

AIM: To observe the influence of the selective decontamination of the digestive tract (SDD) and caecosomy/colonic irrigation on gut endotoxin/bacteria translocation following acute severe pancreatitis (ASP). METHODS: Twenty three pigs weighing 16-22 kg were divided into four groups. Group I (n=5): sham-control; Group Ⅱ (n=6): ASP-control; Group Ⅲ (n=6): gntamicin [(8.55×10⁵±5.70×10⁴)units/time] and nystatin [(1.37×10⁵±9.00×10³)units/time]were fed orally every 8 h for 1 week before the induction of ASP; Group Ⅳ (n=6): caecostomy was performed before the induction of ASP. ASP was induced by infecting 1 mL/kg BW of combined solution of 5% sodium taurocholate and (8-10)×10⁶ BAEE units/L of trypsin into pancreas via pancreatic duct. Systemic plasma endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Specimens of tissue from mesenteriolum and mesocolon lymph nodes, lung, lymph nodes in hilus pulmonis, pancreas and the samples of both portal and systemic blood were collected before and at 72 h following ASP and cultured for aerobic as well as anaerobic bacteria growth. Positive specimens were subcultured and the bacteria identified by standard procedure. RESULTS: Preventive SDD not only effectively reduced the amount of bacteria in stool (P<0.01), but also significantly reduced the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organs and tissues, for instance, mesenteriolum and mesocolon lymph nodes, lung, lymph nodes in hilus pulmonis, pancreas. Early caecostomy/colonic irrigation also significantly reduced the levels of translocated origin-endotoxin and bacteria after ASP. CONCLUSIONS: SDD and caecostomy/colonic irrigation effectively reduce the levels of plasma endotoxin and the magnitude of bacteria translocation to the portal and systemic blood and the remote organ, especially the latter will be of a great importance in the future clinical practice.