呼气氢试验对恶性梗阻性黄疸患者围手术期小肠细菌移位的判断价值

目的:研究恶性梗阻性黄疸患者围手术期血浆内毒素（PE）的动态变化，应用呼气氢试验（HBT）判断小肠细菌的移位及其意义。方法:选择38例可行手术治疗的恶性梗阻性黄疸患者为试验组（A组），健康受试者30例为对照组（B组）。观察A组患者术前、术后PE的变化及HBT的结果，并与B组进行比较。结果:入院时A组PE水平为(0.69±0.22)EU/mL（Endotoxin Unit per mL），与B组（0.17±0.05）EU/ mL相比差异有显著性（P＜0.01）；A组术前1d PE下降不明显（P＞0.05），术后下降显著（P＜0.05）。A组入院时，术前1 d，术后3， 7，14 d HBT阳性率分别为86.8 %，73.7 %，39.5 %，21.1 %和7.9 %；B组阳性率为6.7 %。A组入院时与B组相比差异有显著性（P＜0.05）。A组术后3，7 d与术前1d相比较差异有显著性（P＜0.05）。结论:恶性梗阻性黄疸患者存在肠道细菌移位，合并不同程度的内毒素血症。呼气氢试验是判断恶性黄疸患者围手术期小肠细菌移位的较好指标。

The value of hydrogen breath test in judging of bacterial translocation in the perioperative period of patients with malignant obstructive jaundice

Abstract:Objective:To study the dynamics of plasma endotoxin(PE) levels in the perioperative period of patients with malignant obstructive jaundice, and the significance of hydrogen breath test (HBT) in judging of small intestinal bacterial translocation.Methods :Thirty-eight patients with malignant obstructive jaundice who were suitable for operation, were defined as treatment group (group A, n=38) and 30 healthy individuals were defined as control group (group B, n=30). The changes of PE levels and the results of HBT during the perioperartive period were observed in group A, and compared with group B.Results:On admission to hospital, the PE level in group A ［(0.69±0.22) EU/mL］ and group B ［（0.17±0.05) EU/mL］ was significant difference （P＜0.01）. During the 1 d preoperative period, the PE levels decreased a little（P＞0.05）, but it decreased significantly after operation（all P＜0.05）. The positive rates of HBT in group A at admission, 1 d preoperative and 3 d, 7 d and 14 d after operation, was 86.8％, 73.7％, 39.5 %, 21.1 % and 7.9 %; and it was 6.7 % in group B. The difference was significant between group A before operation and group B; and in group A, comparing postoperative 3 d and 7 d values with preoperative 1 d value, the differences were significant (P＜0.05).Conclusions:The patients with malignant jaundice have small intestinal bacterial translocation and have endotoxemia to some extent. HBT is a valid index for judging bacterial translocation in the perioperative period of patients with malignant obstructive jaundice.