Study On The Effect Of Glutamine Combined With Probiotics On Early Warning Index Of Intestinal Barrier Injury In Patients With Abdominal Surgery And D-lactate And I-FABP

Objective:The perioperative glutamine combined with probiotics were administered to patients with major abdominal surgery to detect and analyze the changes of serum I-FABP,D-lactic acid concentration and E.coli 16SrDNA copy number in the intervention group and the control group.The differences between the clinical outcomes(laboratory examination,postoperative complications,Postoperative hospital stay,hospitalization expenses)of the intervention group and the control group,and the serum I-FABP,D-lactic acid and the clinical outcomes were analyzed.Correlation is intended to provide strong evidence and support for the diagnosis and treatment of intestinal barrier injury in clinical practice.Methods:Randomized controlled patients were enrolled in the second gastrointestinal surgery area of the Second Affiliated Hospital of Kunming Medical University from March 2018 to August 2018.Patients who underwent concurrent surgical treatment according to the inclusion and exclusion criteria of this study;the intervention group was given glutaminePprobiotics were treated and the control group was given routine treatment.Then the peripheral venous blood was taken from the patients within 2 days before surgery,12h,24h and 48h after operation.serum D-lactate,I-FABP concentration was measured and used RT-PCR method to detect 16SrDNA copy number of E.coli in peripheral blood,collect general data of patients,laboratory tests(TP,ALB,PA,ALT,AST,GGT,ALP,TBIL,WBC,PCT.IL-6,CRP),operation time,blood loss,Postoperative complications,postoperative hospital stay and hospitalization expenses;then the serum D-lactic acid,I-FABP concentration,and l6SrDNA copy array of peripheral blood Escherichia coli were compared between the intervention group and the control group.Serum D-lactic acid and I-FABP concentration Pearson Correlation analysis,serum D-lactic acid,I-FABP concentration and clinical outcome analysis,postoperative complications,postoperative hospital stay and hospitalization expenses were compared between the intervention group and the control group.Results:1 General dataThere were 30 patients in the intervention group,including 16 males and 14 females with an average age of 60.38±12.33 years old and BMI 22.73±2.94.There were 30 patients in the control group,including 13 males and 17 females with an average age of 59.25±10.99 years old and BMI 21.56±.3.06;There was no significant difference in age,gender,and BMI between the intervention group and the control group(p>0.05),which was comparable2 Surgical methodsIn the intervention group,6 patients underwent laparoscopic radical gastrectomy,8 underwent radical laparoscopic colon cancer,8 underwent laparoscopic radical res-ection,1 underwent pancreaticoduodenectomy,and 7 underwent partial hepatectomy.The operation time was 3.88±1.21h.The blood loss was 183.33±102.86ml;the control group underwent laparoscopic radical gastrectomy in 7 cases,laparoscopic colon can-cer in 6 cases,laparoscopic rectal cancer in 9 cases,pancreaticoduodenectomy in 2 cases,and hepatectomy in 6 cases.The operation time was 4.22±1.10h,and the blood loss was 229.17±206.10ml.There was no statistical difference in the surgical methods,operation time and blood loss(p>0.05),which was comparable.3 I-FABPIntervention group,preoperative:1013.42±368.59pg/ml,postoperative 12h:935.32±490.41 pg/ml,postoperative 24h:872,48±559.36 pg/ml,Postoperative 48h 555.25±516.74 pg/ml;control group before surgery:986.96±310.25pg/ml,postoperative 12h:1119.44±713.67pg/ml,postoperative 24h:1396.78±601.72pg/ml,postoperative 48h:830.56±509.23pg/ml.Intervention group,intra-group comparison;preoperative VS 48h after surgery,P<0.05;postoperative 12h VS 48h after surgery,P<0.05;postoperative 24h VS 48h after surgery,P<0.05;the remaining time points were no comparison Statistical significance(p>0.05).Control group,intra-group comparison:preoperative VS 24h after surgery,P<0.05;postoperative 12h VS 24h after surgery,P<0.05;postoperative 24hVS 48h after surgery,P<0.05;the remaining time points were not statistically compared Academic significance(p>0.05).The I-FABP intervention group and the control group were compared between the groups;the intervention group was 48h after operation and the control group was 48h after operation,P<0.05;the other time points were not statistically significant(p>0.05).4 D-lactateIntervention group,preoperative:20.09±12.08mg/L,postoperative 12h:16.26±6.46mg/L,postoperative 24h:13.26±5.18mg/L,postoperative 48h:14.26±9.01mg/L;control group,preoperative:20.98±9.79mg/L,postoperative 12h:21.33±8.27mg/L,Postoperative 24h:20.23±8.94mg/L,postoperative 48h:16.06±8.51mg/L.Intervention group,intra-group comparison:preoperative VS 24h after surgery,P<0.05;preoperative VS postoperative 48hs P<0.05;postoperative 12h VS 24h after surgery,P<0.05;the remaining time points were not statistically compared Academic significance(p>0.05).The control group,intra-group comparison:12h after VS3 48h after surgery,P<0.05;the other time points were not statistically significant(p>0.05).The comparison between dhe intervention group and the control group:control group 12h VS intervention group 12h after operation,P<0.05;control group 24h VS intervention group 24h after surgery,P<0.05;the rest of the tirne points were not statistically significant Significance(p>0.05).5 16SrDNA copy number of E.coli in peripheral bloodIntervention group,preoperative:2822.9±1421.43copies/ml,Postoperative 12h:4467.62±1903.56copies/ml,postoperative 24h:3537.17±1686.88copies/ml,postoperative 48h:2293.70±1515.69copies/ml;control group,Preoperative:3025.2±1867.65copies/ml,postoperative 12h:5259.03±2553.53copies/ml,postoperative 24h:3801.52±2332.18copies/ml,postoperative 48h:3185.95±2238.05copies/ml.Intervention group,intra-group comparison:preoperative VS 12h after surgery,P<0.05;preoperative VS 24h after surgery,P<0.05;postoperative 12h VS 24h after surgery,P<0.05;postoperative 12h VS 48h after surgery,P<0.05;24h postoperatively,48h postoperatively,P<0.05.The control group,intra-group comparison:preoperative VS 12h after surgery,P<0.05;preoperative VS 24h after surgery,P<0.05;postoperative 12h VS 24h after surgery,P<0.05;postoperative 12h VS 48h after surgery,P<0.05;24h postoperatively,48h postoperatively,P<0.05.There was no significant difference between the intervention group and the control group at the four time points,p>0.05.6 Laboratory resultsThere were no significant differences between the intervention group and the control group in TP,ALB,PA,ALT,AST,GGT,ALP,TBIL,WBC,PCT,IL-6,and CRP groups(p>0.05).7 Correlation analysisPearson correlation analysis was performed at each time point of I-FABP and D-lactate,and the P value was>0.05,indicating that there was no correlation between I-FABP and D-lactate.Multiple linear regression analysis of TP,ALB,PA,ALT,AST,GGT,ALP,TBIL,WBC,PCT,IL-6,CRP at various time points of I-FABP and D-lactate and laboratory test indicators,P values were all>0.05,indicating that there was no correlation between I-FABP,D-lactate and laboratory test indicators.8 Clinical outcomeThere were 5 cases of SIRS in the intervention group,1 case of wound infection,1 case of abdominal infection,0 cases of pulmonary infection,0 cases of urinary tract infection,1 case of anastomotic leakage,3 cases of total complications,and the postoperative hospital stay was 10.87±2.13.d,hospitalization costs 50497.10 ±14728.93 yuan;13 cases of SIRS occurred in the control group,2 cases of wound infection,2 cases of abdominal infection,1 case of pulmonary infection,1 case of urinary tract infection,1 case of anastomotic leakage,total complications 8 For example,the postoperative hospital stay was 12.30±1.88d,and the hospitalization cost was 52609.59±12641.99 yuan.There were significant differences in the number of SIRS cases,the number of total complications,and postoperative hospital stay between the two groups(P<0.05).There was no significant difference between the other groups(p>0.05).Conclusion:1 The increase of serum I-FABP,D-lactic acid concentration and 16SrDNA copy number of blood Escherichia coli after abdominal surgery has the potential to predict the intestinal barrier damage.2 After glutamine combined with probiotics intervention,the concentration of I-FABP and D-lactic acid was significantly reduced,and it had good reactivity to the intervention.Glutamine combined with probiotics could promote the repair of intestinal barrier and protect the intestinal barrier.3 Glutamine combined with probiotic treatment can improve clinical outcomes in patients undergoing major abdominal surgery.