| Objective:To investigate the effects of perioperative supplementation of glutamine and probiotics on early warning index of postoperative intestinal barrier damage,bacterial translocation,and intestinal mucosal barrier protection in patients undergoing major abdominal surgery.Methods:Sixty patients who underwent major abdominal surgery from March 2018 to September 2018 were randomly divided into control group(30 cases in non-intervention group)and observation group(30 cases in intervention group).Conventional treatment is applied to control group in perioperative period,the observation group was supplemented with glutamine and probiotics on the basis of routine treatment during the perioperative period.Perioperative surgery was performed to observe the perioperative serum citrulline concentration,a-GST concentration,and E.coli 16SrDNA copy number in the two groups before and after surgery,12h after surgery,24h after surgery,and 48h after operation.The effects of glutamine and probiotics on early postoperative intestinal barrier damage,bacterial translocation and clinically relevant outcomes were evaluated to assess the protective effect of perioperative interventions on the intestinal barrier.Results:1.Clinical basic data:There were no significant differences in gender,age,weight,body mass index(BMI),surgical procedure,operation time,and surgical blood loss between the two groups(P>0.05).The two groups were comparable.2.Changes of serum citrulline and a-GST concentration in the two groups:serum citrulline concentration in the two groups:serum citrulline concentration in the control group at 12h after surgery,24h after surgery,48h after surgery and preoperative situation have significant statistical differences(P<0.05);There was no significant difference between the 24h after operation and the 12h after operation,48h after operation and 12h after operation,48h after operation and 24h after operation in the control group(P>0.05).Serum citrulline concentration in the observation group at 12h after surgery,24h after surgery,48h after surgery was significantly different from preoperative results and there was significant difference between 48h after operation and 12h after operation(P<0.05).There was no significant difference between 24h after operation and 12h after operation,48h after operation and 24h after operation(P>0.05).There was no significant difference between the two groups in the serum citrulline concentration before surgery and 12h after operation(P>0.05).There was significant difference between the control group and the observation group at 24 hours after operation and 48 hours after operation(P<0.05).The concentration of citrulline in the observation group began to decrease from 12 hours after operation,but the serum citrulline in the control group kept on decreasing.Serum a-GST concentration was significantly different between 24h after operation and preoperative result,48h after operation and preoperative result in the control group(P<0.05).There was no significant difference between 12h after operation and before operation,24h after operation 12h after operation,48h after operation and 24h after operation,48h after operation and 12h after operation(P>0.05).The serum a-GST concentration in the observation group have statistical difference between 12h after operation and before operation,48h after operation and before operation,24h after operation and 12h after operation,48h after operation and 24h after operation(P<0.05).There was no significant difference between the 24h after operation and the preoperative,48h after surgery and 12h after operation(P<0.05).There was no significant difference in serum a-GST concentration between the the two groups before operation and 12h after surgery(P>0.05),but there was significant difference between the two groups at 24h after operation and 48h after operation(P<0.05).The control group showed an increasing trend after operation,while the a-GST concentration in the observation group did not increase,showing a fluctuating trend.3.The results of comparison of 16srDNA copy number(copies/ml Blood)in peripheral blood of the two groups:It was statistically significant between preoperative result and 12h after operation,preoperative result and 24h after operation,12h after operation and 24h after operation,12h after operation and 48h after operation,24h after operation and 48h after operation in each group(P<0.05),and reached the highest at 12h after operation,and decreased from 12h to 48h after operation.There was no significant difference in the 16srDNA copy number(copies/ml Blood)between the preoperative result and postoperative result at 48h(P>0.05).There was no statistically significant difference between the two groups(P>0.05).4.Statistical results of postoperative clinical outcomes of patients in the two groups:7 cases of postoperative gastrointestinal symptoms(abdominal pain,abdominal distension,diarrhea or gastrointestinal bleeding,1 type at least)occurred in the observation group,and 10 cases in the control group,with an incidence of 23.3%and 33.7%,respectively.Observation group and control group in postoperative SIRS occurred in 5 cases,13 cases respectively,the incidence of 16.7%,43.3%respectively,the difference is statistically significant.Observation group in the abdominal cavity infection,pulmonary infection,urinary tract infection,infection of incision,anastomotic leakage,MODS is 1 case,0 case,0 case,1 case,1 case,0 case,respectively,and the rate of 3.3%,0,0,3.3%,3.3%,0.The control group in the abdominal cavity infection,pulmonary infection,urinary tract infection,infection of incision,anastomotic leakage,MODS is 2 cases,1 case,1 case,2 cases,1 case,1 case respectively.The incidence rate was 6.7%,3.3%,3.3%,6.7%,3.3%,3.3%.The overall complications were statistically different(P<0.05).Postoperative hospitalization time of patients in the observation group was 10.87±2.13 days and 12.30±1.88 days in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in hospitalization cost(P>0.05).Conclusions:1.Intestinal mucosal barrier damage can occur in the early postoperative period in patients undergoing major abdominal surgery.Serum citrate,serum-gst and 16srDNA copy number of peripheral blood escoli can be used as early warning indicators for postoperative intestinal mucosal mechanical barrier damage and bacterial translocation.2.Supplementation with glutamine and probiotics on the basis of perioperative routine treatment in patients undergoing major abdominal surgery can improve the change trend of serum citrate and-gst concentration as early warning indicators of intestinal barrier damage in patients,protect intestinal mucosal mechanical barrier in the early stage,and shorten the length of hospital stay,but have no obvious effect on the displacement of enterogenous bacteria of escherichia coli.3.Supplementation with glutamine and probiotics to protect the intestinal barrier early on the basis of perioperative routine treatment can improve postoperative systemic inflammatory response syndrome(SIRS),overall complication and short postoperative hospitalization time. |
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