INFLUENCE OF PROPHYLACTIC PROBIOTICS AND SELECTIVE DECONTAMINATION ON BACTERIAL TRANSLOCATION IN PATIENTS UNDERGOING PANCREATIC SURGERY: A RANDOMIZED CONTROLLED TRIAL

被引：27

作者：

Diepenhorst, Gwendolyn M. P. ^{[1
,2
]}

van Ruler, Oddeke ^{[1
]}

Besselink, Marc G. H. ^{[3
]}

van Santvoort, Hjalmar C. ^{[3
]}

Wijnandts, Paul R. ^{[4
]}

Renooij, Willem ^{[3
]}

Gouma, Dirk J. ^{[1
]}

Gooszen, Hein G. ^{[3
]}

Boermeester, Marja A. ^{[1
]}

机构：

[1] Univ Amsterdam, Acad Med Ctr, Dept Surg, NL-1105 AZ Amsterdam, Netherlands

[2] Sanquin Res, Dept Immunopathol, Amsterdam, Netherlands

[3] Univ Med Ctr Utrecht, Dept Surg, Utrecht, Netherlands

[4] Univ Amsterdam, Acad Med Ctr, Dept Anaesthesiol, NL-1105 AZ Amsterdam, Netherlands

来源：

SHOCK | 2011年 / 35卷 / 01期

关键词：

Bacterial translocation; selective decontamination of the digestive tract; probiotics; intestinal barrier function; major abdominal surgery; CRITICALLY-ILL; DIGESTIVE-TRACT; BARRIER DYSFUNCTION; CLINICAL-TRIAL; DOUBLE-BLIND; MORTALITY; PATTERNS;

D O I：

10.1097/SHK.0b013e3181ed8f17

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Bacterial translocation (BT) is suspected to play a major role in the development of infections in surgical patients. However, the clinical association between intestinal barrier dysfunction, BT, and septic morbidity has remained unconfirmed. The objective of this study was to study BT in patients undergoing major abdominal surgery and the effects of probiotics, selective decontamination of the digestive tract (SDD), and standard treatment on intestinal barrier function. In a randomized controlled setting, 30 consecutive patients planned for elective pylorus-preserving pancreaticoduodenectomy (PPPD) were allocated to receive perioperatively probiotics, SDD, or standard treatment. To assess intestinal barrier function, intestinal fatty acid-binding protein (mucosal damage) and polyethylene glycol recovery (intestinal permeability) in urine were measured perioperatively. BT was assessed by real-time polymerase chain reaction and multiplex ligation-dependent probe amplification (MLPA) in mesenteric lymph nodes (MLNs) harvested early (baseline control) and at the end of surgery ("end-of-surgery" MLNs, after 3h in PPPD patients). Polymerase chain reaction detected bacterial DNA in 18 of 27 end-of-surgery MLNs and in 13 of 23 control MLNs (P = 0.378). Probiotics and SDD had no significant effect on the number of positive MLNs or the change in bacterial DNA during operation. Multiplex ligation-dependent probe amplification analysis showed significantly increased expression of only 4 of 30 inflammatory mediator-related genes in end-of-surgery compared with early sampled MLN (P < 0.05). Polyethylene glycol recovery was unaffected by operation, probiotics and SDD as compared with standard treatment. Intestinal fatty acid-binding protein levels were increased shortly postoperatively only in patients treated with SDD (P = 0.02). Probiotics and SDD did not influence BT, intestinal permeability, or inflammatory mediator expression. Bacterial translocation after abdominal surgery may be part of normal antigen-sampling processes of the gut.

引用

页码：9 / 16

页数：8

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