严重创伤患者早期肠黏膜屏障功能检测的临床意义  

Determination and clinical significances of early intestinal mucosal barrier in patients with Severe trauma

作　　者：黎宁君[1] 隋明亮 吴长江[1] 胡贤著 朱团结[1] LI Ning -jun SUI Ming - liang WU Chang -fiang et al(Suzhou Kowloon Hosipital, Suzhou 215000, China)

机构地区：[1]苏州九龙医院,江苏苏州215000

出　　处：《吉林医学》2017年第8期1437-1440,共4页Jilin Medical Journal

摘　　要：目的:探讨严重创伤患者早期肠黏膜屏障功能损伤情况及对预后的影响。方法:采用肠道屏障功能生化指标分析系统检测72例严重创伤患者创伤后24 h内的血清二胺氧化酶(DAO)、D-乳酸和内毒素水平,分别按创伤严重程度、是否发生胃肠道功能障碍、是否休克、缺氧、后期合并感染、是否生存分组,并比较不同分组下的血清二胺氧化酶、D-乳酸和内毒素水平的变化。结果:严重创伤组对比创伤较轻组血清早期DAO水平[(7.01±3.07)vs(5.14±1.88)U/L]、D-乳酸水平[(22.23±4.40)vs(14.67±4.58)mg/L]显著升高,差异有统计学意义(P<0.05),血清DAO、D-乳酸水平与APACHEⅡ评分呈正相关关系(DAO/APACHEⅡ评分:r=0.395,P=0.001,D-乳酸/APACHEⅡ评分:r=0.736,P=0.000);胃肠道功能障碍组对比非胃肠道功能障碍组,血清早期DAO水平[(6.42±2.75)vs(5.19±2.19)U/L]、D-乳酸水平[(19.93±5.27)vs(14.79±5.26)mg/L]显著升高,差异有统计学意义(P<0.05);合并休克及ARDS组对比无休克无ARDS组血清D-乳酸[(22.92±3.70)vs(15.578±5.61)mg/L]显著升高,差异有统计学意义(P<0.05);与无明显感染者相比,后期合并感染者早期血清中D-乳酸水平[(20.08±6.02)vs(16.46±5.37)mg/L]、内毒素水平[(9.57±3.62)vs(8.16±1.61)U/L]显著性升高,差异有统计学意义(P<0.05),死亡组对比存活组早期血清中DAO水平[(7.28±3.47)vs(5.39±1.99)U/L]、D-乳酸水平[(22.96±2.55)vs(15.83±5.51)mg/L]均有显著升高,差异有统计学意义(P<0.05)。结论:严重创伤早期即可出现肠黏膜屏障的损伤,以D-乳酸增高较为常见;血清D-乳酸、DAO水平与胃肠功能损害有关;缺氧合并低血压可对肠黏膜屏障功能造成损害;早期肠黏膜屏障受损后期更易出现感染;肠黏膜屏障能一定程度上反应患者预后。Objective To investigate the damages of early intestinal mucosal barrier and their clinical significances and prognostic value in patients with Severe trauma. Method The serum diamine oxidase（ DAO）,D-lactate and endotoxin level in 72 patients with Severe trauma were measured by the intestinal barrier function and biochemical index analysis system in the eraly 24 hours. These 72 patients with Severe trauma were respectively divided into groups according to injury severity,gastrointestinal dysfunction and failure（ GIDF）,shock and/or hyoxemia,the later co-infection,and survival. The serum diamine oxidase,D-lactate and endotoxin level in different groups were analyzed. Results The serum diamine oxidase level[（ 7. 01 ± 3. 07） vs（ 5. 14 ±1. 88） U/L],D-lactate level [（ 22. 23 ± 4. 40） vs（ 14. 67 ± 4. 58） mg/L]were increased significantly in the serious injury group compared with the relatively light trauma group（ P〈0. 05）,APACHEⅡ scores was positively related with serum Diamine oxidase and D-lactate（ DAO/APACHEⅡscore： r = 0. 395,P = 0. 001,D-lactate/APACHE Ⅱ score： r = 0. 736,P = 0. 000）;The serum diamine oxidase level [（ 6. 42 ± 2. 75） vs（ 5. 19 ± 2. 19） U/L],D-lactate level [（ 19. 93 ± 5. 27） vs（ 14. 79 ±5. 26） mg/L] were increased significantly in the GIDF group compared with non-GIDF group（ P〈0. 05）; The serum D-lactate level [（ 22. 92 ± 3. 70） vs（ 15. 578 ± 5. 61） mg/L] was significantly increased in shock and ARDS group compared with non-shock and non-ARDS group（ P〈0. 05）. In later co-infection group,the serum D-lactate level [（ 20. 08 ± 6. 02） vs（ 16. 46 ± 5. 37） mg/L]and endotoxin [（ 9. 57 ± 3. 62） vs（ 8. 16 ± 1. 61） U/L]were significantly increased than in non infection group（ P〈0. 05）; The serum diamine oxidase level[（ 7. 28 ± 3. 47） vs（ 5. 39 ± 1. 99） U/L],D-lactate level [（ 22. 96 ±2. 55） vs（ 15. 83 ± 5. 51） mg/L]were increased significantly in survival group compared with t

关 键 词：创伤 肠黏膜屏障 二胺氧化酶 D-乳酸 内毒素 

分 类 号：R641[医药卫生—外科学]