脓毒症患者的肠屏障功能损伤变化情况探究

李雅琳　　李东风

[摘要] 目的 探討脓毒症患者的肠屏障功能损伤变化情况。 方法 选取2017年10月至2020年4月在本院ICU的30例脓毒症患者设为脓毒症组，另选30例脓毒症休克患者设为脓毒症休克组，所有患者均行酶法测定患者进入住ICU第1天与第3天的细菌内毒素水平以及血清D-乳酸水平，患者入住ICU第3天的CPR（心肺复苏）、急性生理学及慢性健康状况评分、序贯器官衰竭评分。 结果 入住ICU第1天，脓毒症组的血清D-乳酸水平明显低于脓毒症休克组（P<0.05）;脓毒症组与脓毒症休克组患者的细菌内毒素水平比较，差异无统计学意义（P>0.05）;在入住ICU第3天，脓毒症组患者的细菌内毒素水平及血清D-乳酸水平均明显低于脓毒症休克组（P<0.05）;脓毒症组患者入住ICU第3天的CPR、APACHE Ⅱ评分（慢性健康状况评分）、SOFA评分（序贯器官衰竭评分）均明显低于脓毒症休克组（P<0.05）;经检测，入住ICU第1天，脓毒症组患者的细菌内毒素水平均低于脓毒症休克组（P<0.05）;入住ICU第3天，脓毒症组患者的细菌内毒素水平、血清D-乳酸水平明显低于脓毒症休克组（P<0.05）。 结论 脓毒症患者与脓毒症休克患者均发生了不同程度的肠道屏障损伤，肠道屏障损伤的发生与其感染部位无关，与患者疾病的严重程度具有一定的关联。

[关键词] 脓毒症;肠屏障功能;功能损伤;毒素水平

[中图分类号] R459.7          [文献标识码] B          [文章编号] 1673-9701（2021）09-0122-03

Investigation on the changes of intestinal barrier dysfunction in patients with sepsis

LI  Yalin   LI  Dongfeng

Department of Critical Care Medicine， Fuyang People′s Hospital in Anhui Province， Fuyang   236000， China

[Abstract] Objective To explore the changes of intestinal barrier dysfunction in patients with sepsis. Methods A total of 30 patients with sepsis admitted to ICU of our hospital from October 2017 to April 2020 were divided into the sepsis group （n=30， patients with sepsis） and the septic shock group （n=30， patients with sepsis shock）. The bacterial endotoxin levels and serum D-lactic acid levels of patients on the first day and the third day after admission to ICU， the cardiopulmonary resuscitation （CPR）， acute physiology and chronic health status score and sequential organ failure score of patients on the third day after admission to ICU were all measured by enzyme method. Results On the first day of ICU admission， the level of serum D-lactic acid in sepsis group was significantly lower than that in septic shock group（P<0.05）; there was no significant difference in the level of bacterial endotoxin between sepsis group and septic shock group（P>0.05）; on the third day of ICU admission， the level of bacterial endotoxin and serum D-lactic acid in sepsis group were significantly lower than that in septic shock group（P<0.05）; there was no significant difference in the level of bacterial endotoxin between sepsis group and septic shock group（P>0.05）. CPR and Apache on the 3rd day after admission to ICU The scores of chronic health and sofa were significantly lower than those of septic shock group（P<0.05）; the levels of bacterial endotoxin and serum D-lactic acid in septic shock group were significantly lower than those in septic shock group on the first day of ICU admission（P<0.05）; the levels of bacterial endotoxin and serum D-lactic acid in septic group were significantly lower than those in septic shock group on the third day of ICU admission（P<0.05）. Conclusion Both sepsis patients and sepsis shock patients have suffered from intestinal barrier dysfunction in different degrees，which has nothing to do with the infection site， but is related to the severity of patients′ disease.

[Key words] Sepsis; Intestinal barrier dysfunction; Loss of function; Toxin level

肠道功能障碍是许多器官发生功能障碍的主要诱因之一，机体发生休克、严重感染以及大面积烧伤等均可能诱发肠屏障功能损伤，从而使得各种菌群与内毒素进入人体，引起脓毒症，甚至引发器官衰竭。相关学者对动物进行相关实验证明，脓毒症对肠道上皮细胞的凋亡与肠腺窝细胞增殖的变化有一定的关系，也会影响到特定的紧密连接蛋白表达量，从而对肠道形成损伤[1]。本文旨在探讨脓毒症患者的肠屏障功能损伤变化情况，现报道如下。

1 资料与方法

1.1 一般资料

选取我院ICU 2017年10月至2020年4月收治的脓毒症患者中，抽取30例作为脓毒症组，抽取同期脓毒症休克患者30例作为脓毒症休克组。其中脓毒症组男18例，女12例;年龄29～71岁，平均（55.56±2.78）岁;病程1～4 h，平均（2.50±0.40）h。脓毒症休克组男16例，女14例;年龄33～73岁，平均（55.39±2.71）岁;病程2～5 h，平均（2.30±0.30）h。……