选择性肠道去污染对肝硬化大鼠肝门阻断细菌移位、内毒素血症的影响

doi:10.3877/cma.j.issn.1674-0793.2014.02.006

目的

探讨选择性肠道去污染对肝硬化大鼠肝门阻断后肠道细菌移位、内毒素血症的效果。

方法

将制成肝硬化模型的60只雄性SD大鼠随机分为假手术组、肝门阻断30min组（阻断组）及通过选择性肠道去污染预处理组（预处理组），各20只。在实验术后30min及24h时分别取肠系膜淋巴结、肝、肺及门、腔静脉血作细菌培养，并取门、腔静脉血作内毒素检测。

结果

阻断组大鼠手术后30min即出现门、腔静脉血内毒素浓度升高（P<0.01），在手术24 h后升高更明显。并在术后24h肠系膜淋巴结、肝组织及门、腔静脉血细菌培养出现阳性，主要为大肠杆菌。预处理组大鼠无论是手术30min还是24 h后，门、腔静脉内毒素水平升高均不明显，较阻断组明显降低（P<0.01），肠道外组织及门、腔静脉血细菌培养阳性率也明显降低。

结论

肝硬化大鼠肝门阻断30 min后早期即可出现内毒素血症，并于手术24 h后出现明显肠道细菌移位。选择性肠道去污染能减少肝硬化大鼠肝门阻断后肠道细菌移位及内毒素血症的发生。

关键词: 肝硬化, 肝门阻断, 细菌移位, 内毒素血症, 选择性肠道去污染

Objective

To investigate the effect of selective intestinal decontamination on bacterial translocation (BT) and endotoxaemia following Pringle maneuver (Pm) in cirrhotic rats.

Methods

A total of sixty male SD cirrhotic rats were randomly divided into sham operation group, Pm of 30 min group and pretreatment group. Tissue samples from mesenteric lymph nodes (MLNs), liver, lung, portal and vena cava blood were obtained for cultures after 30 minutes and 24 hours of operation. Endotoxin was measured in portal and vena cava blood after 30 minutes and 24 hours of operation.

Results

Portal and vena cava endotoxin levels were significantly increased after 30 minutes, especially 24 hours of operation in Pm of 30 min group(P<0.01). A significant increase in contaminated MLNs, liver, portal and vena cava blood was noted in Pm of 30 min group (P<0.05). E. coli was the most common bacteria isolated from the tissues. Portal and vena cava endotoxin levels were not significantly increased either after 30 minutes or 24 hours of operation in pretreatment group. There was a significant decrease of portal and vena cava endotoxin (P<0.01) and incidence of bacteria translocation by selective intestinal decontamination.

Conclusions

There is endotoxaemia immediately after Pringle maneuver and gut bacteria translocation 24 hours after operation in cirrhotic rats. Selective intestinal decontamination can decrease bacteria translocation and endotoxaemia.

Key words: Cirrhotic, Pringle manoeuvre, Bacterial translocation, Endotoxaemia, Selective intestinal decontamination

图1 肝硬化大鼠肝纤维化程度Ishak分级评分（n=20）

图2 肝硬化大鼠肝脏病理图片，光学显微镜下见大量纤维组织增生，假小叶形成（HE ×200）

表1 手术24h后各组大鼠门、腔静脉血及组织细菌培养结果（n）

组别		n	肠系膜淋巴结	肝组织	肺组织	门静脉血	腔静脉血
假手术组		10	1	0	0	0	0
?	大肠杆菌	?	1	0	0	0	0
阻断组		10	8 ^a	5 ^a	2	5^a	3
?	大肠杆菌	?	6	3	2	3	2
?	变形杆菌	?	1	2	0	1	1
?	肺炎杆菌	?	1	0	0	0	0
?	肠球菌	?	0	0	0	1	0
预处理组		10	1 ^b	0 ^b	0	1	0
?	大肠杆菌	?	1	0	0	0	0
?	肠球菌	?	0	0	0	1	0

表1 手术24h后各组大鼠门、腔静脉血及组织细菌培养结果（n）

组别		n	肠系膜淋巴结	肝组织	肺组织	门静脉血	腔静脉血
假手术组		10	1	0	0	0	0
?	大肠杆菌	?	1	0	0	0	0
阻断组		10	8 ^a	5 ^a	2	5^a	3
?	大肠杆菌	?	6	3	2	3	2
?	变形杆菌	?	1	2	0	1	1
?	肺炎杆菌	?	1	0	0	0	0
?	肠球菌	?	0	0	0	1	0
预处理组		10	1 ^b	0 ^b	0	1	0
?	大肠杆菌	?	1	0	0	0	0
?	肠球菌	?	0	0	0	1	0

图3 3组大鼠术后30 min门、腔静脉内毒素浓度

图4 3组大鼠术后24 h门、腔静脉内毒素浓度

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Effect of selective intestinal decontamination on bacterial translocation and endotoxaemia following Pringle maneuver in cirrhotic rats

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Effect of selective intestinal decontamination on bacterial translocation and endotoxaemia following Pringle maneuver in cirrhotic rats