在外科領域,預防性使用抗生素占有相當重要的地位,這主要是為了預防外科手術部位感染，包括外科手術后的切口感染和手術部位的深部腔隙或器官感染，如胸腔感染、腹腔感染、膿腫形成等。此類感染約占醫院全部感染的14%～16%，占外科患者感染的38%［1］，其重要性不容忽視。
感染病原菌不斷變遷上世紀60年代以前，外科感染病原菌以金黃色葡萄球菌和化膿性鏈球菌為主； 70年代以后，革蘭陽性（G+）球菌的優勢地位逐漸被革蘭陰性（G-）桿菌所代替，主要是以大腸桿菌為代表的腸道桿菌科細菌； 到了90年代，國內、外都注意到G+球菌引起的感染又有增多趨勢，其中凝固酶陰性葡萄球菌和腸球菌的增多尤為突出。在G-需氧桿菌中，腸桿菌屬（陰溝桿菌、產氣桿菌）、綠膿桿菌、不動桿菌、枸櫞酸桿菌等越來越常見，過去鮮為人知的嗜麥芽窄食單胞菌在重癥感染患者中也屢見不鮮。隨著厭氧菌培養技術的普及，厭氧菌感染和有厭氧菌參與的混合細菌感染以及外科危重患者深部真菌感染，越來越多地引起人們的關注。目前在我國，最常見的外科感染病原菌是金黃色葡萄球菌、大腸桿菌和綠膿桿菌，三者共占病原菌的50%以上。其他比較常見的細菌是腸桿菌屬、凝固酶陰性葡萄球菌、腸球菌、不動桿菌和克雷伯菌屬。G-桿菌仍占優勢，約占60%～65%,G+球菌約占30%～35%。另外還有少量真菌。
OBJECTIVE To observe the effects of basic fibroblast growth factor (bFGF) on repairing injury of intestinal mucosa in acute necrotic pancreatitis (ANP). METHODS Sixteen dogs of ANP animal model were made by injection of 5% sodium taurocholate (0.5 ml/kg) with 3,000 U/kg trypsin into the pancreatic duct. The mucosa structure, content of protein, DNA and malondiethylaldehyde (MDA) were observed after ANP and treatment with bFGF, and the plasma lipopolysaccharide and endothelin-1 were detected. The organs of dogs were made to bacterial culture. Ileal mucosa was collected for histological and ultrastructural studies. RESULTS The results showed that after treatment with bFGF, the injury of intestinal mucosa in ANP was abated. The length, height and area of mucosa microvillus, the content of DNA and protein of ileal mucosa were significantly increased, while the plasma endothelin-1 and lipopolysaccharide were reduced. The organ bacterial translocation rate was also decreased in 50%. CONCLUSION bFGF has good effects on abating injury of intestinal mucosa, protecting gut barrier function, reducing the incidence of lipopolysaccharide and bacterial translocation after ANP.
To observe the changes of intestinal bacteriology in acute necrotizing pancreatitis (ANP). Dog ANP model was induced by injection of sodium taurocholate with trypin into the pancreatic duct. All dogs were sacrificed on the seventh postoperative day, mucosal and luminal microflora of intestine were analyzed quantitatively. The blood and organs were collected for culture. The results showed that population levels of E.coli in the intestinal mucosa and the content in cecum of the ANP dogs showed much higher level than those of the controls (Ｐ＜0.01 or Ｐ＜0.05), while bifidobacterium and lactobacillus were decreased significantly (Ｐ＜0.01), resulting in reversal of bifidobacterium/E.coli ratio. Blood levels of endotoxin were 1-2 times higher in ANP group as compare with the controls. The positive rate of blood and organs were 100% in ANP dogs. E.coli were the major bacteria cultured. The results indicated that microecological disturbance could take place after the onset of ANP, which may take an important role on pancreatic infection complicating ANP.
The purpose of the study was to observe effect of chinese medicine “Qing Yi Tang” on the repair of injury of intestinal mucosa in acute necrotizing pancreatitis (ANP). Dogs ANP model were induced by injection of 5% sodium taurocholate (0.5 ml/kg) with 3 000 u/kg trypsin into the pancreatic duct. Diamine oxidase and anylase activity in blood, protein and MDA levels of ileal mucosa were to be determined in ANP and after treatment of “Qing Yi Tang”. Intestinal permeability was also to be studied, LPS and bacteria translocation (BT) were obseved. All animals were sacrificed on day 7, the tissue of ileal mocosa was collected for histological and ultrastructural studies. The results showed that after treatment with Chinese medicine “Qing Yi Tang”, the injury of intestinal mucosa in ANP reduced. The length, height, area and protein of ileal mucosa increased significantly, intestinal permenbility decreased, the levels of LPS reduced in 1-2 times, and organ BT rate also reduce in 50%. The results indicated that chinese medicine “Qing Yi Tang” had good effect on improving repair of intestinal mucosa injury, protecting gut barrier function, reducing the incidence of LPS and bacteria translocation.
【Abstract】Objective To investigate the preventive role of selective decontamination of the digestive tract (SDD) in gut-originated endotoxemia in acute necrotizing pancreatitis (ANP). Methods A lethal model of ANP was reproduced in Wistar rats by retrograde infusion of artificial bile into the main pancreatic duct. Normal control group (n=6), sham operation group (n=6), ANP group (n=14) and ANP+SDD (polymycin E, tobramycin and nystatin mixture) group (n=8) were randomly devided. Visceral pathologic changes, serum levels of TNFα and IL-1β, intestinal bacterial flora, plasma D(-)lactate and endotoxin contents, as well as the mortality were examined at 72h after operation in each group. Results Necrosis and inflammation of pancreas, with a remarkable elevation of serum TNFα and IL-1β and intestinal flora disturbance (with E.Coli content risen significantly) were seen in ANP rats. Simultaneously, ANP rats displayed elevated plasma concentration of D(-)lactate and endotoxin. In SDD group, enterobacteraceae and yeast were markedly depressed, while anaerobes were well preserved, with the value of B/E 〔Bifidobacterium/E.Coli, log10(CFU/CFU）〕 elevated in the ileac mucous membrane (1.73±1.23 vs -0.37±0.72 in ANP group,P＜0.01) and in the caecum content (∞ vs 0.88±0.77). In addition, depressed levels of D(-)lactate 〔（3.95±1.83） mg/L vs （8.05±3.05） mg/L in ANP group,P＜0.01〕, endotoxin 〔（0.227±0.084） EU/ml vs （0.423±0.155） EU/ml in ANP group, P＜0.01〕 and TNFα 〔（15.41±10.32） ng/L vs （46.79±24.31） ng/L in ANP group P＜0.01〕 in systemic or portal vein were observed in the SDD group. Moreover, SDD group displayed a declined 72h mortality(14.3% vs 58.8% in ANP group, P=0.005). Conclusion ANP is associated with gut barrier disorder and gut flora imbalance, which may exacerbate the process of gut-originated endotoxin translocation. By protecting gut flora and gut barrier against disorder, SDD attenuates ANPrelated endotoxemia and improves the outcome. SDD is advisable for the prophylaxis of gut-originated endotoxemia complicated from ANP.
【Abstract】Objective To investigate the effects of tension-free herniorrhaphy on endocrine functions of patients with inguinal hernia. MethodsOne hundred and twenty-seven patients were randomly divided into tension-free group(n=65) and conventional group (n=62). The mean ages of tension-free group and conventional group were(51.8±14) year and(48.4±12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension-free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, Cpeptide and and glucose. The data were analysed through t test. ResultsThe levels of cortisol, C-peptide and glucose in conventional group were remarkably higher (P6”0.05) while the levels of T3,TSH were notably lower (P＜0.05) than those in tension-free group at 3 h, 24 h postoperatively, the level of insulin in conventional group was significantly higher than that in tension-free group at 24 h postoperatively. ConclusionThe results of this study indicate that tension-free repair imposes less influence on the endocrine functions of patients with inguinal hernia postoperatively than conventional repair does. This might explain pathophysiologically the quick recovery of the patients receiving tension-free herniorrhaphy.