New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery 英文参考文献.docVIP

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New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery 英文参考文献.doc

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New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery 英文参考文献

NewInsightinLossofGutBarrierduringMajorNon- AbdominalSurgery JoepP.M.Derikx1*,DickA.vanWaardenburg2,GeertjeThuijls1,Henrie¨tteM.Willigers3 ,Marianne Koenraads1,AnnemarieA.vanBijnen1,ErikHeineman1,MartijnPoeze1,TonAmbergen4,Andre′ van Ooij5,LodewijkW.vanRhijn5,WimA.Buurman1 1Department of Surgery, University Hospital Maastricht Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, the Netherlands, 2DepartmentofPaediatrics,UniversityHospitalMaastricht,Maastricht,theNetherlands,3DepartmentofAnaesthesiology,UniversityHospitalMaastricht,Maastricht,the Netherlands,4DepartmentofMethodologyandStatistics,UniversityofMaastricht,Maastricht,theNetherlands,5DepartmentofOrthopaedicSurgery,UniversityHospital Maastricht,Maastricht,theNetherlands Abstract Background:Gutbarrierlosshasbeenimplicatedasacriticaleventintheoccurrenceofpostoperativecomplications.We aimedtostudythedevelopmentofgutbarrierlossinpatientsundergoingmajornon-abdominalsurgery. Methodology/PrincipalFindings:Twentyconsecutivechildrenundergoingspinalfusionsurgerywereincluded.Thiskind ofsurgeryischaracterizedbylongoperationtime,significantbloodloss,prolongedsystemichypotension,withoutdirectly leadingtocompromiseoftheintestinesbyintestinalmanipulationoruseofextracorporealcirculation.Bloodwascollected preoperatively,everytwohoursduringsurgeryand2,4,15and24hourspostoperatively.Gutmucosalbarrierwasassessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusionwas measuredby gastric tonometry(PrCO2,Pr-aCO2-gap). Plasmaconcentration ofI-FABP, I- BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively,allmarkersdecreasedpromptlytowardsbaselinevaluestogetherwithnormalisationofMAP.Plasmalevels ofI-FABP,I-BABPweresignificantlynegativelycorrelatedwithMAPatKhourbeforebloodsampling(20.726(p,0.001), 20.483 (P,0.001), respe