The Study On The Correlation Between The Intestinal Endotoxemia And The Functional State Of The Organs

[Objective]To further explore the characteristics and the changing regularity of the intestinal endotoxemia in critical patients.To investigate the relationship between the intestinal endotoxemia and the state of system organ's function and immunity. From this study we wish to improve our prevention and treatment to critical patients with the intestinal endotoxemia to some extent.[Methods]41 samples of critical surgical patients suffering from gut dysfunction and MODS in SICU were prospective observed.When it combines with the intestinal dysfunction and the multiple organ dysfunction syndrome(MODS),we observe the APACHE-Ⅱscore,the number of the organs with the functional lesions,the level of the endotoxin in the blood,and the condition of turnover.The patients are divided into groups on the basis of their age,APACHE-Ⅱscore and prognosis,and then we observe the difference of the level of the Endotoxemia,mortality and the characteristics of the cytokine and immune state.At the same time,the patients were treated with the combination of the TCM and Western medicine,an then we observe the changing rule of the L/M in the urine,endotoxin,Th1/Th2 and HLA-DR before the treatment and on the 3rd and 7th days after being treated.[Result]①Among all the kinds of diseases,the.APACHE-Ⅱscore,the number of the organs with the functional lesions,the level of the endotoxin in the blood,and mortality bear no significant deviations(p＞0.05),and the level of endotoxin of all the patients is higher than the normal level;②Among the organs and systems with functional damage,the lung stays in the first plays except the intestine;③Among the age groups,the level of the endotoxin has no big difference(p＞0.05), but there are obviously difference among the APACHE-Ⅱscore,the number of the organs with the functional lesions,and mortality.The age is a independent risk factor for the mortality of the surgical critical diseases;④The comparison of the different severities finds that the number of the organs with the functional lesions,the number of WBC,the L/M in the urine,the level of the endotoxin,the cytokine,the immune state and the mortality almost have clear diferences;⑤If the groups are divided on the basis of prognosis,the L/M and the level of the endotoxin of the curing group and survival group descengs on the 7th day after being treated,and it bears statistical significances,but the L/M and the level of the endotoxin of the death group raises obviouely.The migration of the Th1/Th2 of the curing group have statistical significances on the 3rd and 7th day after being treated,and the descending of the Th1/Th2 in the survival group has statistical significances on the 7th day after being treated.However,the dynamic observation of the Th1/Th2 in the death group indicates that it has a clear downtrend on the 3rd day,and it is obviously lower than the normal value on the 7th day.The changing of HLA-DR on the 3rd day has no statistical significance,and the increasing of the curing group on the 7th day has statistical significances,but the HLA-DR of the death group descends significantly.[Conclusion]In the stress state,such as the severe trauma,surgery and so on, the intestinal tract is liable to be attacked by the factors of infections,ischemia or reperfusion and so on,which leads to the damage of the intestinal barrier function,the translocation of the bacterium and endotoxin.All the above form the intestinal endotoxin,and initiate SIRS,sepsis and MODS subsequently.This research finds that the intestinal endotoxin has a close relationship with the severity,the degree of the lesion of the intestinal barrier,and the prognosis.In the early stage,it has a positive correlation with the Th1/Th2,and following the combined treatment of the TCM and Western medicine,the level of the endotoxin can be lowered,and the immune state can also be regulated,and then the Th1 migrates to Th2,which goes to a balance. The expression of HLA-DR recovers gradually,and the prognosis is fine.However,if the pathologic condition aggravates unceasingly,when the severe sepsis and the immune failure appear,the Th1/Th2 and HLA-DR always descend to the utmost,and the anti-inflammatory response overacts,which leads to the depression of the immune function.The level of the endotoxin raises unceasingly,which induce to the uncontrolled sepsis,MODS,or even death.For this reason,we should pay attention to the continuous damage of the endotoxemia in the surgical critical diseases,and regulate the immune function in time.We should think highly of the functions of the traditional Chinese medicine,such as regulating the immune function,removing the endotoxin and protect the organs' function.The combined treatment of the TCM and Western medicine is to be the developing direction of the prevention and cure of the intestinal endotoxemia.