在外科领域,预防性使用抗生素占有相当重要的地位,这主要是为了预防外科手术部位感染，包括外科手术后的切口感染和手术部位的深部腔隙或器官感染，如胸腔感染、腹腔感染、脓肿形成等。此类感染约占医院全部感染的14%～16%，占外科患者感染的38%［1］，其重要性不容忽视。
感染病原菌不断变迁上世纪60年代以前，外科感染病原菌以金黄色葡萄球菌和化脓性链球菌为主； 70年代以后，革兰阳性（G+）球菌的优势地位逐渐被革兰阴性（G-）杆菌所代替，主要是以大肠杆菌为代表的肠道杆菌科细菌； 到了90年代，国内、外都注意到G+球菌引起的感染又有增多趋势，其中凝固酶阴性葡萄球菌和肠球菌的增多尤为突出。在G-需氧杆菌中，肠杆菌属（阴沟杆菌、产气杆菌）、绿脓杆菌、不动杆菌、枸橼酸杆菌等越来越常见，过去鲜为人知的嗜麦芽窄食单胞菌在重症感染患者中也屡见不鲜。随着厌氧菌培养技术的普及，厌氧菌感染和有厌氧菌参与的混合细菌感染以及外科危重患者深部真菌感染，越来越多地引起人们的关注。目前在我国，最常见的外科感染病原菌是金黄色葡萄球菌、大肠杆菌和绿脓杆菌，三者共占病原菌的50%以上。其他比较常见的细菌是肠杆菌属、凝固酶阴性葡萄球菌、肠球菌、不动杆菌和克雷伯菌属。G-杆菌仍占优势，约占60%～65%,G+球菌约占30%～35%。另外还有少量真菌。
To observe the changes of intestinal bacteriology in acute necrotizing pancreatitis (ANP). Dog ANP model was induced by injection of sodium taurocholate with trypin into the pancreatic duct. All dogs were sacrificed on the seventh postoperative day, mucosal and luminal microflora of intestine were analyzed quantitatively. The blood and organs were collected for culture. The results showed that population levels of E.coli in the intestinal mucosa and the content in cecum of the ANP dogs showed much higher level than those of the controls (Ｐ＜0.01 or Ｐ＜0.05), while bifidobacterium and lactobacillus were decreased significantly (Ｐ＜0.01), resulting in reversal of bifidobacterium/E.coli ratio. Blood levels of endotoxin were 1-2 times higher in ANP group as compare with the controls. The positive rate of blood and organs were 100% in ANP dogs. E.coli were the major bacteria cultured. The results indicated that microecological disturbance could take place after the onset of ANP, which may take an important role on pancreatic infection complicating ANP.
The purpose of the study was to observe effect of chinese medicine “Qing Yi Tang” on the repair of injury of intestinal mucosa in acute necrotizing pancreatitis (ANP). Dogs ANP model were induced by injection of 5% sodium taurocholate (0.5 ml/kg) with 3 000 u/kg trypsin into the pancreatic duct. Diamine oxidase and anylase activity in blood, protein and MDA levels of ileal mucosa were to be determined in ANP and after treatment of “Qing Yi Tang”. Intestinal permeability was also to be studied, LPS and bacteria translocation (BT) were obseved. All animals were sacrificed on day 7, the tissue of ileal mocosa was collected for histological and ultrastructural studies. The results showed that after treatment with Chinese medicine “Qing Yi Tang”, the injury of intestinal mucosa in ANP reduced. The length, height, area and protein of ileal mucosa increased significantly, intestinal permenbility decreased, the levels of LPS reduced in 1-2 times, and organ BT rate also reduce in 50%. The results indicated that chinese medicine “Qing Yi Tang” had good effect on improving repair of intestinal mucosa injury, protecting gut barrier function, reducing the incidence of LPS and bacteria translocation.
OBJECTIVE To observe the effects of basic fibroblast growth factor (bFGF) on repairing injury of intestinal mucosa in acute necrotic pancreatitis (ANP). METHODS Sixteen dogs of ANP animal model were made by injection of 5% sodium taurocholate (0.5 ml/kg) with 3,000 U/kg trypsin into the pancreatic duct. The mucosa structure, content of protein, DNA and malondiethylaldehyde (MDA) were observed after ANP and treatment with bFGF, and the plasma lipopolysaccharide and endothelin-1 were detected. The organs of dogs were made to bacterial culture. Ileal mucosa was collected for histological and ultrastructural studies. RESULTS The results showed that after treatment with bFGF, the injury of intestinal mucosa in ANP was abated. The length, height and area of mucosa microvillus, the content of DNA and protein of ileal mucosa were significantly increased, while the plasma endothelin-1 and lipopolysaccharide were reduced. The organ bacterial translocation rate was also decreased in 50%. CONCLUSION bFGF has good effects on abating injury of intestinal mucosa, protecting gut barrier function, reducing the incidence of lipopolysaccharide and bacterial translocation after ANP.
【Abstract】Objective To investigate the preventive role of selective decontamination of the digestive tract (SDD) in gut-originated endotoxemia in acute necrotizing pancreatitis (ANP). Methods A lethal model of ANP was reproduced in Wistar rats by retrograde infusion of artificial bile into the main pancreatic duct. Normal control group (n=6), sham operation group (n=6), ANP group (n=14) and ANP+SDD (polymycin E, tobramycin and nystatin mixture) group (n=8) were randomly devided. Visceral pathologic changes, serum levels of TNFα and IL-1β, intestinal bacterial flora, plasma D(-)lactate and endotoxin contents, as well as the mortality were examined at 72h after operation in each group. Results Necrosis and inflammation of pancreas, with a remarkable elevation of serum TNFα and IL-1β and intestinal flora disturbance (with E.Coli content risen significantly) were seen in ANP rats. Simultaneously, ANP rats displayed elevated plasma concentration of D(-)lactate and endotoxin. In SDD group, enterobacteraceae and yeast were markedly depressed, while anaerobes were well preserved, with the value of B/E 〔Bifidobacterium/E.Coli, log10(CFU/CFU）〕 elevated in the ileac mucous membrane (1.73±1.23 vs -0.37±0.72 in ANP group,P＜0.01) and in the caecum content (∞ vs 0.88±0.77). In addition, depressed levels of D(-)lactate 〔（3.95±1.83） mg/L vs （8.05±3.05） mg/L in ANP group,P＜0.01〕, endotoxin 〔（0.227±0.084） EU/ml vs （0.423±0.155） EU/ml in ANP group, P＜0.01〕 and TNFα 〔（15.41±10.32） ng/L vs （46.79±24.31） ng/L in ANP group P＜0.01〕 in systemic or portal vein were observed in the SDD group. Moreover, SDD group displayed a declined 72h mortality(14.3% vs 58.8% in ANP group, P=0.005). Conclusion ANP is associated with gut barrier disorder and gut flora imbalance, which may exacerbate the process of gut-originated endotoxin translocation. By protecting gut flora and gut barrier against disorder, SDD attenuates ANPrelated endotoxemia and improves the outcome. SDD is advisable for the prophylaxis of gut-originated endotoxemia complicated from ANP.
【Abstract】Objective To investigate the effects of tension-free herniorrhaphy on endocrine functions of patients with inguinal hernia. MethodsOne hundred and twenty-seven patients were randomly divided into tension-free group(n=65) and conventional group (n=62). The mean ages of tension-free group and conventional group were(51.8±14) year and(48.4±12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension-free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, Cpeptide and and glucose. The data were analysed through t test. ResultsThe levels of cortisol, C-peptide and glucose in conventional group were remarkably higher (P6”0.05) while the levels of T3,TSH were notably lower (P＜0.05) than those in tension-free group at 3 h, 24 h postoperatively, the level of insulin in conventional group was significantly higher than that in tension-free group at 24 h postoperatively. ConclusionThe results of this study indicate that tension-free repair imposes less influence on the endocrine functions of patients with inguinal hernia postoperatively than conventional repair does. This might explain pathophysiologically the quick recovery of the patients receiving tension-free herniorrhaphy.