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目的探讨不伴失血性休克状态下的不同的程度创伤性肝破裂后肠屏障功能变化及临床意义。方法检测84例不伴失血性休克的不同程度创伤性肝破裂患者在术前和术后血浆D-乳酸、二胺氧化酶、内毒素水平,30例腹股沟疝患者为对照组。结果肝破裂Ⅱ级以上者的血浆D-乳酸、二胺氧化酶、内毒素水平明显增高,肝破裂Ⅲ级以上者伤后6 h血浆D-乳酸、二胺氧化酶、内毒素水平明显增高,伤后72 h仍明显增高(P<0.01)。结论不伴失血性休克状态下的创伤性肝破裂同时有肠屏障的损害,伤势越严重,肠屏障的损害出现越早,且越严重;创伤性肝破裂后应注意保护肠屏障,伤势越重越应尽早保护肠屏障。
Objective To explore the changes of intestinal barrier function after traumatic liver rupture and its clinical significance in different degrees without hemorrhagic shock. Methods The levels of plasma D-lactate, diamine oxidase and endotoxin in 84 patients with traumatic liver rupture without hemorrhagic shock and 30 patients with inguinal hernia were measured before and after operation as the control group. Results The levels of plasma D-lactate, diamine oxidase and endotoxin were significantly higher in patients with grade Ⅱ or higher of hepatic rupture. The level of plasma D-lactate, diamine oxidase and endotoxin were significantly increased at 6 h after rupture of grade Ⅲ, 72 h after injury was still significantly higher (P <0.01). Conclusions The traumatic liver rupture without hemorrhagic shock has the damage of intestinal barrier at the same time. The more severe the injury is, the earlier the damage of intestinal barrier appears, and the more severe the damage is. The traumatic liver rupture should pay attention to the protection of intestinal barrier, As soon as possible to protect the gut barrier.