小儿重症阑尾炎细菌移位早期干预的临床研究

发布时间：2018-03-05 07:22

本文选题：阑尾炎　切入点：细菌移位　出处：《山西医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的探讨小儿重症阑尾炎细菌移位引起免疫功能变化及丙氨酰谷氨酰胺强化的肠外营养液早期干预的临床研究。方法根据患儿病情轻重将其分为两组，其中急性化脓性阑尾炎并穿孔合并泛发性腹膜炎、肠梗阻、腹腔多发脓肿或早期感染性休克为重症组，急性化脓性阑尾炎合并局限性腹膜炎为普通组，术后两组患儿在接受同等级别抗生素的基础上，重症组早期添加丙氨酰谷氨酰胺（1.5ml/kg.d）强化的肠外营养液治疗，常规治疗7d，两组患儿术前、术后7d分别抽外周静脉血5ml，应用聚合酶链反应（PCR）定性检测患儿全血细菌DNA（细菌共有的16SrRNA、大肠杆菌BG）；采用密度梯度离心法分离出单个核细胞(MNC)，加入抗CD3、CD4、CD8单抗，用流式细胞仪检测T（CD3+），Th（CD3+CD4+）,Ts(CD3+CD8+）,Th/Ts( CD4+/CD8+）；同时监测血系列及观察患者术后并发症、胃肠道功能、肝功及营养支持治疗不良反应等。结果术前重症组16SrRNA，BG阳性率均较普通组升高，术后7d，两组16SrRNA阳性率，，BG阳性率水平接近；术前重症组T（CD3+）、Th（CD3+CD4+）、Th/Ts（CD4+/ CD8+）水平较普通组明显降低(P0.05)，术后7d,两组恢复正常，无统计学差异(P0.05)；术前重症组Ts(CD3+CD8+）较普通组降低，无统计学差异(P0.05)，术后7d,两组水平接近；术前白细胞及C反应蛋白均较正常水平升高，术后7d两组白细胞均恢复正常，重症组CRP较普通组降低水平更为明显(P0.05)；肝功及肾功术前术后均无明显差异(P0.05)。结论丙氨酰谷氨酰胺强化的肠外营养液术后早期干预小儿重症阑尾炎，对细菌移位具有防治作用，可减轻肠粘膜损害，增强机体免疫促进术后恢复，简单实用并发症少。
[Abstract]:Objective to investigate the changes of immune function induced by bacterial translocation in children with severe appendicitis and the early intervention of alanyl glutamine fortified parenteral nutrition solution. Methods the children were divided into two groups according to the severity of the disease. Acute suppurative appendicitis with perforation combined with generalized peritonitis, intestinal obstruction, multiple abscesses in abdominal cavity or early septic shock were used as severe group. Acute suppurative appendicitis combined with localized peritonitis was treated with parenteral nutrition solution of 1.5 ml / kg 路d of alanyl glutamine in severe group on the basis of receiving antibiotics of the same grade. Routine treatment for 7 days, two groups of children before operation, On the 7th day after operation, peripheral venous blood was drawn from 5 ml, and the bacterial DNA (16s rRNA, Escherichia coli BGN) was qualitatively detected by polymerase chain reaction (PCR), and the mononuclear cells (MNCX) were isolated by density gradient centrifugation and added anti-CD3 + CD4 + CD8 monoclonal antibody. Flow cytometry was used to detect the TsT / T / T / T / T (CD4 / CD 8) CD8, and to observe the postoperative complications, gastrointestinal function, liver function and adverse effects of nutrition support. Results the positive rate of 16s rRNA CD4 in the severe group was higher than that in the normal group before operation, and the positive rate of 16s rRNA in the two groups was close to that in the control group at 7 days after operation, and the level of Thr / Tstsmb CD4 / CD8 in the preoperative severe group was significantly lower than that in the normal group, and recovered to normal on the 7th day after operation, and the positive rate of 16s rRNA in the severe group was higher than that in the normal group. There was no significant difference in Ts(CD3 CD8 between the two groups (P 0.05), but there was no significant difference between the two groups on the 7th day after operation, the levels of WBC and C-reactive protein in the two groups were higher than those in the normal group, and the white blood cells returned to normal at 7 days after operation. The level of CRP in severe group was significantly lower than that in normal group (P 0.05), and there was no significant difference in liver function and renal function before and after operation. Conclusion early intervention of alanyl-glutamine enhanced parenteral nutrition solution in children with severe appendicitis can prevent and cure bacterial translocation, reduce intestinal mucosal damage, enhance body immunity and promote postoperative recovery, with few simple and practical complications.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R726.5

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