Study On Gut Barrier Dysfunction And Bacterial Translocation In Patients After Upper Digestive Tract Reconstruction

Objective:To investigate the relationship between bacterial translocation(BT)and acute systemic inflammatory state (SIRS) in patients who underwent upper digestive tract reconstruction.Methods:60 patients who underwent selective digestive tract reconstruction were observed. Blood were collected before surgery and 1,3,5d after surgery to detect D-lactate and bacterial DNA.PCR analysis was performed with P-Galactosidase gene of Eschenchia coli and 16SrRNA gene as target gene. The SIRS of all the patients were observed for 10 days.Results:All the PCR results before operation were negative, while there was positive in 14 patients after digestive tract reconstruction.85.7% of the patient (12/14) with positive PCR result had SIRS while 21.7% patients (10/46) with negative PCR result did have SIRS (p<0.01).The positive PCR rate in SIRS was 54.5%(12/22), which was remarkably higher than that without SIRS5.3%(2/38) (p<0.01).The positive PCR rate in major operations was 38.5%(10/26), which was higher than that in moderate operations(11.8%,4/34) (p<0.05).The plasma levels of D-lactate in patient with positive PCR result was significantly higher than those of the patients with negative PCR result (p<0.01). The plasma level of D-lactate in patients with SIRS was significantly higher than that of without (p<0.01). The plasma levels of D-lactate in major operations was significantly higher that in moderate operations((p<0.01).Conclusion:The study suggested that the gut barrier dysfunction could occurr in patients undergoing upper digestive tract reconstruction, leading to BT.The severity of trauma and intestinal ischemia might be one of the significant factors for BT.Visceral angiospasm induced by trauma and anesthesia, intestinal ischemia and anoxemia caused by blood loss, ischemia—reperfusion injury might collectively contribute to BT. The gut barrier dysfunction was closely related to BT; BT was closely related to postoperative SIRS.PCR analysis can be used to detect BT early,the positive PCR result might be a useful early warning sign of postoperative SIRS.