阑尾炎论文：小儿重症阑尾炎细菌移位早期干预的临床研究.docVIP

阑尾炎论文：小儿重症阑尾炎细菌移位早期干预的临床研究 【中文摘要】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。 【英文摘要】s To explore changes in the level of immune function by bacterialtranslocation ,early intervention and clinical significance of Alanyl-glutamine enhancedparenteral nutrition on bacterial translocation in critically ill children with severe appendicitis.Methods Divided children into two groups according to severity ,with acute suppurativeappendicitis and perforation ,the merger of generalized peritonitis, intestinal obstruction,abdominal abscess or multiple early septic shock as severe group, the limitations peritonitis ofacute suppurative appendicitis as an ordinary group,Two groups of children receivingantibiotics which was based on the same level, while,the severe group was addedalanyl-glutamine (1.5ml/kg.d) enhanced parenteral nutrition , treatment for 7 daysconventionally,two groups of all children before surgery，7d after the operation peripheralvenous blood were taken respectively 5ml,PCR detection of bacteria in whole blood; Isolatemononuclear cells (MNC) by density gradient centrifugation , added Anti-CD3, CD4 and CD8monoclonal antibodies to the anticoagulant, at dark room for 30 min, fixed after dark to standfor 30 min, and finally by flow cytometry (BD) detection of T (CD3 +),