PROPHYLACTIC EFFECTS OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT ON GUT-ORIGINATED ENDOTOXEMIA COMPLICATED FROM ACUTE NECROTIZING PANCREATITIS_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DENG Qun ¹ , LI Zhanliang ¹ , XIONG Dexin. ²

Department of General Surgery, 304th Hospital of Chinese People’s Liberation Army, Beijing 100037;

Corresponding author：

Keywords：

Acute necrotizing pancreatitis Endotoxin Selective decontamination of the digestive tract

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【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 ANPrelated endotoxemia and improves the outcome. SDD is advisable for the prophylaxis of gut-originated endotoxemia complicated from ANP.

Citation： DENG Qun,LI Zhanliang,XIONG Dexin.. PROPHYLACTIC EFFECTS OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT ON GUT-ORIGINATED ENDOTOXEMIA COMPLICATED FROM ACUTE NECROTIZING PANCREATITIS. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2001, 8(6): 361-363下转366. doi: Copy

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1. Medich DS, Lee TK, Melhem MF, et al. Pathogenesis of pancreatic sepsis 〔Ｊ〕. Am J Surg, 1993； 165(1)∶46.
2. Tokyay R, Zeigler ST, Traber DL. Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation 〔Ｊ〕. J Appl Physiol, 1993; 74(4)∶1521.
3. Smith SM, Eng HK, Buccini F. Use of Dlactic acid measurement in the diagnosis of bacterial infections 〔Ｊ〕. J Infect Dis, 1985; 154(4)∶658.
4. Yao YM, Yu Y, Wu Y, et al. Plasma D(-)lactate as a new marker for diagnosis of acute intestinal injury following ischemiareperfusion 〔Ｊ〕. China Natl J New Gastroenterol, 1997; 3(4)∶225.
5. Runkel WSF,Moody FG,Smith GS,et al. The role of the gut in the development of sepsis in acute pancreatitis 〔Ｊ〕. J Surg Res, 1991; 51(1)∶18.
6. Manson WL, Klasen HJ, Sauer EW, et al. Selective intestinal decontamination for prevention of wound colonization in severily burned patients: a retrospective analysis 〔Ｊ〕. Burns, 1992; 18(2)∶98.
7. Lingnau W, Berger J, Javorsky F, et al. Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial 〔Ｊ〕. J Trauma, 1997; 42(4)∶687.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

PROPHYLACTIC EFFECTS OF SELECTIVE DECONTAMINATION OF THE DIGESTIVE TRACT ON GUT-ORIGINATED ENDOTOXEMIA COMPLICATED FROM ACUTE NECROTIZING PANCREATITIS

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