Effect Of Preoperative Gastrointestinal Comprehensive Treatment On Inflammatory Response In Patient With Cardiopulmonary Bypass

ObjectiveTo observe the effect of preoperative gastrointestinal comprehensive treatment(Selective Digestive tract Decontamination joint Gastrointestinal Flora Alternative)on Endotoxin concentration in plasma and Inflammatory Response in Patient withcardiopulmonary bypass（CPB）.MethodsThirty cases undergoing heart valve replacement（including MVR and AVR）operations approved by Human Rights Commission were recruited randomly fromDepartment of cardiovascular surgery，the First Affiliated Hospital of NanchangUniversity，Male or Female.ASA Ⅱ～Ⅲ.All patients were randomly divided intotwo groups， Conventional group (Group C): the line of conventional surgery forbowel preparation before: diet preparation (preoperative one day light and a smallresidue soft diet, fasting morning surgery) and the night before surgery cleanenema.1days in the integrated treatment group (A): diet preparation (preoperativelight a small residue soft diet, fasting morning surgery) and the night before surgerycleansing enema;3days before surgery, patients began to oral: levofloxacin0.2g2times/day, manifold triple viable capsule (brand name: Bifico)2times/day,montmorillonite powder (trade name: Smecta) bag of3times/day. Exclusioncriteria: patients with combined endocrine and nervous systemic disease, severehypertension, severe anemia, severe liver and kidney dysfunction; digestive diseases(such as acute and chronic ulcerative gastrointestinal tract disease, Crohn’s disease,ulcerative colitis,necrotizing colitis, acute and chronic cholecystitis, obstructivejaundice and gastrointestinal tumors) to exclude.2groups patients, respectively、before induction of anesthesia (T1)、CPB, end immediately (T2)、 CPB, the end of24h (T3)、CPB, the end of48h (T4) total of four detect the endotoxin, interleukin6(IL-6), procalcitonin (PCT) determination. Observation records two groups ofpatients, cardiopulmonary bypass time, aortic cross-clamping time, aortic heart after resuscitation rate, postoperative ventilator use,24hours after a positive inotropicdrug dosage and intensive care unit stay time. Measurement data using the mean±standard deviation (x±s) said, diverse groups of this mean were compared usingpaired t-test, analysis of variance was used to compare the two groups. Statisticalanalysis of data SPSS17.0package is complete. P <0.05was considered statisticallysignificant.Results1. Two groups of patients, cardiopulmonary bypass time, aortic cross-clampingtime, aortic automatically reset after the opening of the heart beat rate, ventilator careunit stay were not significantly different (P>0.05).2. After the start of the cardiopulmonary bypass, endotoxin, interleukin6(IL-6),procalcitonin (PCT) concentrations were higher than before induction of anesthesia(P <0.05), and the emergence of the first and then decreased peakimmediately afterCPB (T2); A group in T2, T3, two points of plasma endotoxin, serum IL-6concentrations were lower than group C (P <0.05); T1~T4four pointno significantdifference between group A serum PCT concentration in group C group (P>0.05).3. Positive inotropic drugs within24hours after the use of a dopamine dosage,321±56.03mg group C, dopamine dosage of623±76.03mg A group of epinephrinedosage of0.73±0.11mg group C epinephrine dosage2.15±0.73mg. Between thetwo groups were significantly different (P <0.01).ConclusionsThis study shows that preoperative gastrointestinal comprehensive treatment(selective digestive tract decontamination joint gastrointestinal flora alternative) forcardiopulmonary bypass in patients with preoperative gastrointestinal preparatorywork, the maintenance of gastrointestinal mucosal barrier function, reducingcardiopulmonary bypass in patients with perioperative plasmaendotoxin levels,reduce the level of inflammatory response.