EFFECTS OF INTESTINAL LAVAGE ON PATIENTS WITH SEPTIC MULTIPLE ORGAN FAILURE

1)本临床研究探讨15例感染性休克患者血浆循环炎性因子、血浆NOx水平及可溶性Fas对急性肺损伤及其他器官功能衰竭的影响；7名患者存活，其他8名患者未存活。非幸存者的平均PaO2/FIO2比低于幸存者（108±28比177±37；mean±SD）。虽然非幸存者的血浆平均Nox水平和sFas浓度远高于幸存者（Nox; 112.4±27.4 vs. 68.5±30.3 μ M/L, sFas; 3.3±1.2 vs. 1.4±0.5 U/ml），但PaO2/FIO2比值与血浆Nox或sFas浓度之间没有相关性。本实验研究了盲肠结扎穿刺（CLP）和肝脏缺血再灌注（I/R）大鼠血浆炎症因子、血浆Nox水平、肺和肝组织sFas和Fas表达。虽然CLP大鼠血浆NOx水平高于I/R大鼠（33.5±2）。大于8 vs. 26.2±1.9 μ M/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。Western blot检测CLP大鼠肺和肝脏中66千道尔顿分子量Fas的表达量均低于I/R大鼠。本临床研究和动物实验结果提示，血浆Nox水平轻微升高对急性肺损伤的发生无影响，细胞凋亡对脓毒症患者脓毒症相关肺损伤的影响较小，但对I/R相关肝损伤有重要作用。2)测定14例脓毒症合并高胆红素血症患者的二胺氧化酶（DAO）活性、IL-6、IL-8、IL-10和sFas。总胆红素和直接胆红素的平均水平分别为7.8±1.0mg/dl和5.0±0.6mg/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。sFas平均水平为5.2±0.8ng/ml。总胆红素值与sFas浓度、IL-6/IL-10、DAO水平与sFas、IL-6/10比值呈显著相关。这些临床研究结果表明，血浆DAO水平升高显示肠道缺血改变，高胆红素血症与高细胞分裂血症或细胞凋亡相关。但由于本研究中只有4例知情同意的患者接受了开孔洗肠治疗，因此本研究无法证实肠灌洗对高红血素血症的影响。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