住院脓毒症患者肠屏障状况及其影响因素研究

Study on influencing factors of intestinal barrier in hospitalized patients with sepsis

摘要:

目的 探索住院脓毒症患者肠屏障状况及影响因素。方法 选择2012 年1 月-2017 年1 月海南医 学院第一附属医院ICU 收治的脓毒症患者108 例，根据患者是否发生休克将患者分为脓毒症组（63 例）、脓 毒性休克组（45 例），另选取普通手术后未发生脓毒症的患者74 例为对照组。患者入院后检测血清D- 乳酸、 内毒素、肠型脂肪酸结合蛋白（IFABP），以及急性生理学与慢性健康状况（APACHE Ⅱ）评分和超敏C 反 应蛋白（hsCRP）。结果 3 组患者之间比较血清D- 乳酸和内毒素含量，差异有统计学意义（P <0.05）；脓毒 症组和脓毒性休克组高于对照组，脓毒性休克组高于脓毒症组；腹腔感染患者与非腹腔感染患者指标差异有 统计学意义（P <0.05），腹腔感染患者高于非腹腔感染患者；死亡患者与未死亡患者的指标差异有统计学意 义（P <0.05），死亡患者高于未死亡患者；脓毒感染患者血清D- 乳酸、内毒素与APACHE Ⅱ评分、IFABP、 机械通气时间呈正相关（P <0.05），而与hsCRP 无相关（P >0.05）。结论 脓毒症患者肠道屏障功能与患者疾 病的严重程度和肠道缺血密切相关，且屏障功能受损越严重，患者预后越差。

Abstract:

Objective To explore the intestinal barrier status and its influencing factors in hospitalized patients with sepsis. Methods From January 2012 to January 2017, 108 patients with sepsis treated in the ICU of our hospital were selected and divided into a sepsis group (n = 63) and a septic shock group (n = 45) according to whether the patients had shock or not. And 74 patients who did not have sepsis after general surgery were selected as the control group. The serum D-lactate, endotoxin, intestinal fatty acid binding protein (IFABP), Acute Physiology and Chronic Health Evaluation (APACHE) score and high-sensitivity C-reactive protein (hs-CRP) were detected after the patients were admitted to our hospital. Results The serum D-lactic acid and endotoxin in the sepsis group and the septic shock group were significantly higher than those in the control group, the serum D- lactic acid and endotoxin in the septic shock group were significantly higher than those in the sepsis group, the differences were statistically significant (P < 0.05). The levels of D-lactic acid and endotoxin in the patients with abdominal infection were significantly higher than those in the non-abdominal infection patients (P < 0.05). The serum levels of D-lactic acid and endotoxin were significantly higher in the dead patients than in the alive patients (P < 0.05). The serum D-lactic acid and endotoxin levels of the patients were positively correlated with APACHEII score, IFABP and mechanical ventilation time (P < 0.05), but were not correlated with hs-CRP (P > 0.05). Conclusions The intestinal barrier function of the patients with sepsis is closely related to the severity of the disease and intestinal ischemia, and the more severe the impairment of the barrier function is, the worse the prognosis is.