Relationship Between Gastrointestinal Dysfunction And Changes Of Plasma IFABP, LPS, PCT Levels And PHi In Patients With Severe Multiple Injury

ObjectiveMultiple organ dysfunction syndrome(MODS) is one of the most severe complications occurred in severe trauma,shock,infection and major operation.The occurrence and development of MODS is a continuous pathophsiological process,in which gastrointestinal dysfunction plays a vital role.It is very important to prevent the occurrence of MODS if we could take precaution early and take effective measures against gastrointestinal dysfunction.The aim of the study is to analyse the correlation and clinical significance of gastrointestinal dysfunction with plasma iFABP,LPS,PCT and pHi levels in patients with severe multiple injury so as to provide theoretic and experimental evidence for predicting the gastrointestinal dysfunction after trauma.Materials and methodsThirty-six patients with severe multiple injury were divided into minor injury(ISS＜16) group(15 patients) and severe multiple injury(ISS＞16) group(21 patients) according to ISS score and divided into gastrointestinal dysfunction group(32 patients) and non-gastrointestinal dysfunction group(4 patients) based on with or without gastrointestinal dysfunction.Ten patients of selective operation were served as the control group. Semi-random control trial was taken.Venous blood was collected from control group once but from other two groups at days 1,3 and 5 respectively after trauma.The blood used to measure plasma iFABP and LPS was centrifuged at 1500 g for 15 minutes and then immediately stored in icebox at -80℃.The blood to measure plasma PCT was sent to the Clinical Laboratory of our hospital.The concentration of plasma iFABP was measured by enzyme linked immunosorbent assay technique,concentration of plasma LPS by dynamic turbidity method and concentration of plasma PCT by immunochromatography.The level of pHi was measured by Datex-Ohmeda Tonometrics. Results1.Compared to the control group,the iFABP levels in the minor injury group and the severe injury group were both increased obviously at day 1 after trauma(P＜0.01),with higer level in the severe injury group than that in the minor injury group(P＜0.01). Subsequently,the iFABP level in the minor injury group decreased and recovered to normal at day 5 after trauma but that in the severe injury group was increased obviously(P＜0.01). Compared to the non-gastrointestinal dysfunction group,the level in the gastrointestinal dysfunction group was increased at day 1(P＜0.05),which became remarkable at days 3 and 5 after trauma(P＜0.01).The level of the iFABP was highly relevant to the degree of gastrointestinal dysfunction(P＜0.01).2.Compared to the control group,the LPS levels in the minor injury group and severe injury group were both increased remarkably at days 1 and 3 after trauma(P＜0.01). Compared to the minor injury group,the level in the severe injury group was elevated at day 1 after trauma(P＜0.05),which was remarkable at day 3 after trauma(P＜0.01).The LPS level in the minor injury group at day 3 was higher than that at day 1 after trauma (P＜0.05) and the level in the severe injury group was increased remarkably(P＜0.01). Compared to the non-gastrointestinal group,the plasma LPS level in gastrointestinal dysfunction group was remarkably increased at days 1 and 3 after trauma(P＜0.01).The level of the LPS is highly relevant to the degree of gastrointestinal dysfunction(P＜0.01).3.Compared to the control group,the PCT level in the minor injury group was increased remarkably at day 1 after trauma(P＜0.01) and was increased at day 3 after trauma(P＜0.05),and the level in the severe injury group increased remarkably at days 1 and 3 after trauma(P＜0.01).Compared to the minor injury group,the PCT level in the severe injury group was increased remarkably at days 1 and 3 after trauma(P＜0.01).The PCT level in the minor injury group decreased at day 3 than 1 after trauma(P＜0.05),but the level was higher than that of the control group(P＜0.05).The level in gastrointestinal dysfunction group was remarkable higher than that of the non gastrointestinal dysfunction group at days 1 and 3 after trauma(P＜0.01).The level of PCT was highly relevant to the degree of gastrointestinal dysfunction at day 1 after trauma(P＜0.05),and relevant obviously to that at day 3 after trauma(P＜0.01 ).4.Compared to the control group,the pHi levels in the minor injury group and the severe injury group were decreased obviously at day 1(P＜0.01) and the level in the severe injury group was lower than that of the minor injury group(P＜0.05),but at day 3,the levels in the minor injury group and the severe injury group recoverd to normal.The level of the pHi had significantly negative correlation with the degree of gastrointestinal dysfunction at day 1 after trauma(P＜0.05),but the correlation was not obviously at day 3 after trauma.5.In the multiple injury patients,there was significantly positive correlations among plasma iFABP,LPS and PCT levels,which was highly relevant to the degree of gastrointestinal dysfunction at days 1 and 3 after trauma.There was remarkably negative correlation between the level of iFABP,PCT and pHi at day 1 after trauma,and the level of pHi was negatively related to the degree of gastrointestinal dysfunction at day 1 after trauma.ConclusionsAll plasma iFABP,LPS and PCT levels in the multiple injury patients show significant increase after trauma,which is highly relevant to injury severity and degree of gastrointestinal dysfunction.There is significantly positive correlation between plasma iFABP,LPS and PCT levels.The level of the pHi is decreased obviously,which shows highly negative relation with the plasma iFABP and PCT levels and with degree of gastrointestinal dysfunction at day 1 after trauma.Therefore,at the early stage after severe trauma,the level of plasma iFABP,LPS,PCT and pHi may play an important role in early predition of the gastrointestinal dysfunction.