Clinical investigation of intestinal barrier dysfunction in septic patients / 中华急诊医学杂志

ABSTRACT

Objective To investigate the intestinal barrier dysfunction in sepsis and septic shock patients,and to analyze the relationship between infection site and the severity of the disease.Methods A prospective observational research was carried out in 42 sepsis patients,47 septic shock patients and 36 postoperative patients without sepsis as control admitted to Department of Critical Care Medicine of General Hospital of Ningxia Medical University from November 2015 to June 2017.Blood samples were collected from patients on the first day and the third day after admission to the intensive care unit (ICU) to measure D-lactic acid and endotoxin levels of sepsis and septic shock patients by enzymatic method,while the blood sample of control group was just tested on the first day.Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score of patients were recorded on the first day after admission.Sepsis and septic shock patients were divided into intra-abdominal infection group(n=54) and extra-abdominal infection group(n=35).Results (1) Compared with control group,D-lactic acid and endotoxin levels in sepsis patients and septic shock patiems were significantly higher on the first day and third day (all P＜0.01).There were no significant differences in D-lactic acid and endotoxin between sepsis group and septic shock group on the first day (both P＞0.05),but endotoxin level of septic shock group was higher than that in sepsis group(P＜0.05) and there was no significant differences in D-lactic acid level between these two groups (P＞0.05) on the third day.(2) In the intra-abdomen infection group,there were no significant differences in D-lactic acid and entotoxin between sepsis patients and septic shock patients on the first day and the third day after admission (all P＞0.05).(3)There were no significant differences in D-lactic acid and endotoxin between intra-abdominal infection group and extra-abdominal infection group on the first day and the third day after admission(all P＞0.05).Conclusions Sepsis and septic shock patients often have intestinal barrier dysfunction.The dysfunction is correlated with the severity of disease,but there is no relationship with the infective site.Endotoxin is superior to blood D-lactic acid in reflecting the severity of sepsis.