烧伤后肠源性高代谢研究——高代谢及内毒素  

Research of Enterogenous Hypermetabolism in Burns——Hypermetabolism & Endotoxin

作　　者：汪仕良[1] 尤忠义[1] 余斌[1] 王凤君[1] 彭曦[1] 赵云[1] 王裴[1] 王少龙[1] 陈忠勇[1] 黎鳌[1] 

机构地区：[1]第三军医大学西南医院烧伤研究所,重庆400038

出　　处：《肠外与肠内营养》2005年第1期24-28,共5页Parenteral & Enteral Nutrition

摘　　要：目的 :探讨烧伤后高代谢与内毒素的关系。　方法 :观察了 4 0例严重烧伤病人 ,烧伤总面积达 (45±11.3) % ,其中深度烧伤为 (2 9.7± 10 .4 ) %。观察指标为静息能量消耗 (REE)、血浆内毒素、丙二醛 (MDA)、超氧化物歧化酶 (SOD)、肿瘤坏死因子 (TNF)、白细胞介素 8(IL 8)、高血糖素、皮质醇、血清二胺氧化酶 (DAO)及尿乳果糖 /甘露醇比值 (L/M)、尿儿茶酚胺。　结果 :①烧伤后 1～ 14天观察期间 ,REE与血浆内毒素、TNF、IL 8、高血糖素呈显著相关 (r分别为 0 .5 985、0 .92 36、0 .8381、0 .85 17,P分别为 0 .0 14 3、0 .0 0 11、0 .0 0 94、0 .0 0 73) ;血清DAO与血浆SOD呈显著负相关 (r=- 0 .7871,P =0 .0 2 0 4 ) ,尿L/M与血浆SOD、MDA亦呈显著相关 (r =- 0 .9114、0 .94 4 5 ,P=0 .0 0 16、0 .0 0 0 4 )。②复苏期后 (伤后 4～ 14天 ) ,REE与SOD呈显著负相关 (r=- 0 .7180 ,P <0 .0 5 )。　结论 :烧伤后高代谢与内毒素、TNF、IL 8、高血糖素有关 ,伤后肠道损伤与早期缺血 再灌注损伤有关 ,血内毒素增高可能与肠道损伤所致的肠道内毒素移位有关。Objectives: To study the relationship between hypermetabolism and endotoxin. Methods: Since the middle of 1980s, on the basis of observing more than 800 animals(miniswine, rabbit,rat,guineapig) and 250 burn patients, 40 severe cases with TBSA (45±11.3)% and deep burn (29.7± 10.4 )% were investigated. The indices of REE(resting energy expenditure), plasma endotoxin,MDA,SOD,DAO (diamine oxydase), TNF, IL-8, glucagon,cortisol, and urine catecholamine,urine ratio of lactulose/mannitol(L/M) were observed. Results: ①During whole course of burn \[PBD (post burn day) 1～14\],the levels of plasma endotoxin, TNF, IL-8, glucagon and the variations of REE correlated significantly(r=0.598 5,0.923 6,0.838 1,0.851 7; P=0.014 3,0.001 1,0.009 4,0.007 3); the extent of plasma DAO was correlated negatively with the level of plasma SOD (r=-0.787 1, P= 0.020 4 );the variations of L/M were correlated to plasma SOD and MDA (r=-0.911 4,0.944 5; P=0.001 6,0.000 4).② After resuscitation stage of burn injury (PBD 4～14),levels of REE were negatively correlated with extent of plasma SOD(r=-0.718 0,P<0.05). Conclusions: The effect of endotoxin ,TNF,IL-8 and glucagon on the level of REE are sustained,the postburn gut injury is accompanied by ischemia reperfusion injury, and the hypermetabolism induced by burns may be through gut endotoxin translocation.

关 键 词：烧伤 血浆内毒素 高血糖素 TNF 肠道损伤 肠源性高代谢 IL-8 伤病 结论 负相关 

分 类 号：R644[医药卫生—外科学] R575[医药卫生—临床医学]