Intestinal permeability, circulating endotoxin, and postoperative systemic responses in cardiac surgery patients
Intestinal permeability, circulating endotoxin, and postoperative systemic responses in cardiac surgery patients
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DOI：
10.1016/s1053-0770(96)80235-7
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发表时间：
1996-02-01
影响因子：
2.8
通讯作者：
Eysman, L
中科院分区：
文献类型：
--
作者：
OudemansvanStraaten, HM;Jansen, PGM;Eysman, L
目的：确定心脏手术期间肠道通透性是否增加，以及内毒素血症的程度是否与这种增加有关。此外，为了确定肠通透性是否与手术过程中的血流动力学状态和术后全身反应有关。设计：前瞻性研究。设置：大学医院。参与者：23名接受择期冠状动脉搭桥手术的男性患者。干预措施：在手术前和术后第五天，100毫升的溶液中含有L-鼠李糖和纤维二糖administer.Measurements和主要结果：肠道通透性进行了评估，通过测量L-鼠李糖和纤维二糖的尿排泄。测量血液和预充液中的内毒素浓度、血流动力学、耗氧量、气体交换、液体平衡和血管活性药物的剂量。通过测量高代谢来评估全身反应。循环支持和气体交换纤维二糖的肠道渗透反映了细胞旁转运，在手术期间显着增加（p < 0.01），并与循环内毒素的量相关（r（2）= 0.46; p < 0.01）。术中使用高剂量麻黄碱、基线中心静脉压低、术中液体正平衡差与肠通透性高相关（r（2）= 0.7; p < 0.01）。肠道通透性与术后全身反应有关（r（2）= 0.49; p < 0.01）。结论：择期冠状动脉旁路移植术时肠道细胞间通透性增加。内毒素血症的程度与这种增加有关。肠通透性增加与麻黄素的使用有关，尤其是在血容量不足时，也与术后全身反应有关。虽然没有显示因果关系，这些结果可能表明，低血容量和血管收缩，应避免在手术中。(C)1996年，W.B.桑德斯公司
Objectives: To determine whether intestinal permeability increases during cardiac operations, and whether the degree of endotoxemia is related to this increase. Furthermore, to determine whether intestinal permeability is related to the hemodynamic state during operation and to postoperative systemic responses.Design: Prospective study.Setting: University hospital.Participants: Twenty-three male patients undergoing elective coronary artery bypass surgery.Interventions: Before surgery and during the fifth postoperative day, 100 mL of a solution containing L-rhamnose and cellobiose were administered orally.Measurements and Main Results: Intestinal permeability was assessed by measuring the urinary excretion of L-rhamnose and cellobiose. Endotoxin concentrations in blood and prime fluid, hemodynamics, oxygen consumption, gas exchange, fluid balance, and the dose of vasoactive drugs were measured. Systemic responses were assessed by measuring hypermetabolism. circulatory support, and gas exchange. Intestinal permeation of cellobiose, reflecting paracellular transport, significantly increased during operation (p < 0.01), and correlated with the amount of circulating endotoxin (r(2) = 0.46; p < 0.01). A high dose of ephedrine administered during operation, low baseline central venous pressure, and a less positive fluid balance during operation were associated with high intestinal permeability (r(2) = 0.7; p < 0.01). Intestinal permeability was related to postoperative systemic responses (r(2) = 0.49; p < 0.01).Conclusions: This study shows that during elective coronary artery bypass operations intestinal permeability between cells may increase. The degree of endotoxemia is related to this increase. Increased intestinal permeability is related to the use of ephedrine, especially during hypovolemia, and to postoperative systemic responses. Although a causative relation is not shown, these results might indicate that hypovolemia and vasoconstriction should be avoided during the operation. (C) 1996 by W.B. Saunders Company