早期肠内营养对肝移植术后肠屏障及细菌移位的影响  

Effects of early enteral nutrition on gut mucosal barrier and bacterial translocation after liver transplantation

作　　者：夏强[1] 鱼晓波[1] 张建军[1] 陈小松[1] 张明[1] 李齐根[1] 罗毅[1] 沈从欢[1] 邢天宇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院器官移植中心,上海市200127

出　　处：《中华肝胆外科杂志》2007年第2期94-97,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨早期肠内营养对肝移植术后病人肠屏障功能和细菌移位的影响。方法40名肝移植病人被随机分成早期肠内营养（EN）组、胃肠外营养（PN）组。术前、术后第1天及术后第8天检测血浆内毒素水平、D-乳酸水平及二胺氧化酶（DAO）水平，术前及术后第1～7天每日行外周血细菌聚合酶链反应（PCR）检测及血细菌培养。结果（1）术后第8天EN组内毒素、D-乳酸及DAO水平显著低于PN组（P〈0．01）。（2）术后第1天两组内毒素、D-乳酸及DAO水平显著高于术前（P〈0．05），两组之间无统计学差异。术后第8天EN组内毒素、D-乳酸及DAO水平显著低于术后第1天水平（P〈0．05），低于术前水平（P〈0．05）。PN组内毒素、D-乳酸及DAO水平显著高于术前水平（P〈0．05），和术后第1天水平无统计学差异（P〉0．05）。（3）40例肝移植病人PCR检测外周血细菌DNA片段阳性总数为25例，阳性率62．5％，术后第4天起两组有显著差异。（4）PCR大肠杆菌检出占所有细菌检出的60％。（5）40名肝移植病人27例出现全身炎症反应综合征（SIRS），其中EN组12例，PN组15例，PCR阳性组SIRS发生率为96％，PCR阴性组SIRS发生率为20％，SIRS发生组PCR阳性率为88．89％，SIRS阴性组PCR阳性率为7．69％。（6）术后血细菌培养阳性率27．5％，显著低于PCR的62．5％（P〈0．01）；培养阳性者，PCR均呈阳性。（7）PCR阳性组感染并发症发生率为64％（16／25），阴性组均未发生感染（0／15），二者差异有显著性（P〈0．01）。结论肝移植术后施行早期肠内营养能有效的维护肠黏膜屏障功能、防止细菌及内毒素移位，减少术后感染的发生。Objective To investigate the effects of early enteral nutrition （EN） on gut mucosal barrier and bacterial translocation after liver transplantation. Methods A randomized controlled clinical trial was conducted to compare the role of early EN with parenteral nutrition （PN） in 40 patients after liver transplantation. The plasma levels of D（-）-lactate, DAO and endotoxin were determined preoperatively and on the 1st and 8th d after operation. Meanwhile, the blood microbial DNA was detected preoperatively and at the 1-7 d after operation using PCR and hemoculture. Results The plasma level of D（-）-lactate, DAO and endotoxin were significantly lower in EN group than in PN group on the 8th d after operation （P〈0. 01）. The plasma levels of D（-）-lactate, DAO and endotoxin were markedly higher on the 1st d after than before the operation （P〈0.05）. There were no remarkable differences in the levels between the 2 groups （P〉0. 05）. In the EN group, the levels of the 3 parameters on the 8th d after operation were significantly lower than those before and on the 1st d after operation （P〈0. 05）. In the PN group, the levels on the 8th d after operation were markedly higher than those before operation （P〈0. 05） but not significantly different from those on the 1st d after operation （P〉0. 05）. The bacterial DNA detection was positive in 25 patients （62.5%） after operation and there was difference in the rate of positive detection between the 2 groups. E coli DNA was found in 60% of the PCR positive cases. Of the 27 patients with SIRS, 12 belonged to EN group and 15 to PN group. SIRS appeared in 96% of the PCR-positive patients and 20% of the negative ones （P〈0.01）. PCR positivity was found in 88. 89 % of SIRS-positive patients and 7.69 % of the SIRS-negative ones （P〈0. 01）. The positive rate of hemoculture was only 27.5%, which was markedly lower than that of PCR. Infectious complications developed in 64% of PCR-positive patients and none of the PCR-negative one

关 键 词：肝移植 肠内营养 肠屏障 细菌移位 

分 类 号：R686[医药卫生—骨科学]