EFFECTS OF INTESTINAL LAVAGE ON PATIENTS WITH SEPTIC MULTIPLE ORGAN FAILURE

1)本研究观察了15例感染性休克患者(存活7例，死亡8例)血浆循环炎性细胞因子、血浆NOx水平及可溶性Fas在急性肺损伤及其他器官衰竭中的作用。死亡组平均PaO2/FiO2低于存活组(108±28比177±37；平均值±SD)。虽然死亡患者的血浆平均NOx水平和sFas水平显著高于存活者(112.4±27.4vs.68.5±30.3microM/L，sFas；3.3±1.2vs.1.4±0.5U/ml)，但未发现PaO2/FiO2与血浆NOx和sFas浓度之间的相关性。本实验观察了盲肠结扎穿孔(CLP)和肝脏缺血再灌注(I/R)大鼠血浆炎性细胞因子、血浆NOx水平、肺和肝组织sFas和Fas的表达。尽管慢性阻塞性肺疾病大鼠血浆NOx水平高于I/R大鼠(33.5±2.…大于8vs.26.2±1.9microM/L)，这些值被认为是最小的。CLP大鼠血浆sFas浓度低于I/R大鼠。免疫印迹结果显示，CLP大鼠肺和肝脏66kD分子量Fas的表达明显低于I/R大鼠。本研究的临床研究和动物实验结果表明，血浆NOx水平轻微升高对急性肺损伤的发生无影响，细胞凋亡对脓毒症相关的肺损伤影响不大，但对I/R相关的肝损伤有重要影响。总胆红素为7.8±1.0 mg/dl，直接胆红素为5.1±0.6 mg/dl。IL-6、IL-8和IL-10的平均值分别为146.8±35.3pg/ml、120.6±14.4pg/ml和197.5±43.5pg/ml。血浆总胆红素水平与sFas浓度、IL-6/IL-10、DAO水平及sFas/IL-6/10比值呈显著正相关，提示血浆DAO水平升高表现为肠道缺血性改变，高胆红素血症与高细胞分裂素血症或细胞凋亡有关。但是，在这项研究中，由于只有4名患者在知情同意的情况下接受了穿孔灌肠治疗，因此在这项研究中无法证明洗肠对高双氢红素血症的影响。较少

1) In the present clinical study, the effects of plasma circulating inflammatory cytokines, plasma NOx levels and soluble Fas on acute lung injury and other organ failure were investigated in fifteen septic shock patients; seven patients were survivor and the other eight were nonsurvivor. The average PaO2/FIO2 ratio in nonsurvivors was lower than that in survivors (108±28 vs. 177±37; mean ±SD). Although plasma average Nox levels and sFas concentrations in nonsurvivors were much higher than those in survivors (Nox; 112.4±27.4 vs. 68.5 ±30.3 micro M/L, sFas; 3.3 ±1.2 vs. 1.4 ±0.5 U/ml), no correlation was found between PaO2/FIO2 ratio and Plasma Nox or sFas concentrations. In the present animal investigation, plasma inflammatory cytokines, plasma Nox levels, sFas and Fas expression in lung and liver tissues were investigated in cecal ligation and puncture (CLP) and liver ischemic reperfusion (I/R) rats. Although plasma levels of NOx in CLP rats were higher than those of I/R rats (33.5±2. … More 8 vs. 26.2±1.9 micro M/L), these values were considered minimal. Plasma sFas concentrations in CLP rats were lower than that in I/R rats. The expression of 66 kilodalton molecular weight Fas with Western blot in the lungs and the livers of CLP rats were less than that in I/R rats.The results of this clinical study and animal investigation suggest that a slightly elevated plasma Nox level has no effect on onset of acute lung injury and that apoptosis has only a slight effect on sepsis related lung injury in patients with sepsis but has some important effects on I/R related liver injury.2) Next, diamine oxidase (DAO) activity, IL-6, IL-8, IL-10 and sFas were measured in 14 septic patients with hyperbilirubinemia. The average total and direct bilirubin levels were 7.8±1.0mg/dl and 5.l±0.6mg/dl. The average IL-6, IL-8 and IL-10 were 146.8±35.3pg/ml, 120.6±14.4pg/ml and 197.5±43.5pg/ml, respectively. The average sFas level was 5.2±0.8ng/ml. Significant correlations were found in total birilubin value and sFas concentrations, IL-6/IL-10 and in DAO levels and sFas, IL-6/10 ratio.These results of this clinical study suggests that the increased plasma DAO level showed ischemic change in the gut and hyperbirirubinemia correlated to hypercytokinemia or apoptosis. But effects of gut lavage on hyperbirilubinemia could not be proven in this study, because only 4 patients with informed consent of this study were treated with hole gut lavage. Less