Gut permeability in paediatric cardiac surgery
Gut permeability in paediatric cardiac surgery
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DOI：
10.1093/bja/aei014
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发表时间：
2005-02-01
影响因子：
9.8
通讯作者：
Hazekamp, MG
中科院分区：
文献类型：
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作者：
Malagon, I;Onkenhout, W;Hazekamp, MG
背景肠粘膜缺血可发生在婴儿和儿童心脏手术期间和之后。粘膜灌注严重减少可能导致并发症，如坏死性小肠结肠炎和术后死亡。我们采用双重糖渗透试验和其他两种糖的吸收研究了接受心脏手术的儿科患者的肠道渗透性。研究了34例接受姑息性或矫正性外科手术的患者，其中有和没有心肺转流术。在麻醉诱导后及12和24 h后，用3-O-甲基-D-葡萄糖、D-木糖、L-鼠李糖和乳果糖测定小肠通透性。乳果糖/鼠李糖比值从一开始就升高[中位数为0.39（接受非体外循环手术的患者的置信区间为0.07-1.8，接受体外循环手术的患者的置信区间为0.30（0.02-2.6）]。最高的乳果糖/鼠李糖比率记录术后12小时0.32（0.07-6.9），当使用心肺转流。这大约是健康儿童预期值的7倍。未接受心肺转流术的患者有所改善：麻醉诱导后12 h和24 h分别为0.22（0.03-0.85）和0.11（0-0.48）。行主动脉缩窄修补术的患者恢复最快：麻醉诱导后12 h和24 h分别为0.09（0.03-0.31）和0.07（0.04-0.35）。与同龄健康儿童相比，先天性心脏病患者的肠道通透性异常。心脏搭桥术似乎在形态上（乳果糖和鼠李糖吸收）和功能上（3-O-甲基-d-葡萄糖和d-木糖吸收）影响肠屏障。
Background. Intestinal mucosal ischaemia can occur in infants and children during and after cardiac surgery. Severe decreases in mucosal perfusion may cause complications such as necrotizing enterocolitis and postoperative mortality. We investigated gut permeability in paediatric patients undergoing cardiac surgery using the dual sugar permeability test and absorption of two other saccharides.Methods. Thirty-four patients undergoing palliative or corrective surgical procedures with and without cardiopulmonary bypass were investigated. Intestinal permeability was measured using 3-O-methyl-d-glucose, d-xylose, l-rhamnose and lactulose, given orally after induction of anaesthesia and 12 and 24 h later.Results. Lactulose/rhamnose ratios were raised from the outset [median 0.39 (confidence interval 0.07-1.8 for patients undergoing operations without cardiopulmonary bypass and 0.30 (0.02-2.6) with cardiopulmonary bypass]. The highest lactulose/rhamnose ratios were recorded 12 h after surgery 0.32 (0.07-6.9), when cardiopulmonary bypass was used. This is approximately seven times the value expected in healthy children. There was an improvement in patients not undergoing cardiopulmonary bypass: 0.22 (0.03-0.85) 12 h and 0.11 (0-0.48) 24 h after induction of anaesthesia. Patients undergoing repair of aortic coarctation showed the fastest recovery: 0.09 (0.03-0.31) 12 h and 0.07 (0.04-0.35) 24 h after induction of anaesthesia.Conclusions. Patients with congenital heart defects have abnormal gut permeability when compared with healthy children of similar age. Cardiopulmonary bypass seems to affect the intestinal barrier morphologically (lactulose and rhamnose absorption) and functionally (3-O-methyl-d-glucose and d-xylose absorption).