本文選題：闌尾炎　切入點(diǎn)：細(xì)菌移位　出處：《山西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討小兒重癥闌尾炎細(xì)菌移位引起免疫功能變化及丙氨酰谷氨酰胺強(qiáng)化的腸外營養(yǎng)液早期干預(yù)的臨床研究。 方法根據(jù)患兒病情輕重將其分為兩組，其中急性化膿性闌尾炎并穿孔合并泛發(fā)性腹膜炎、腸梗阻、腹腔多發(fā)膿腫或早期感染性休克為重癥組，急性化膿性闌尾炎合并局限性腹膜炎為普通組，術(shù)后兩組患兒在接受同等級(jí)別抗生素的基礎(chǔ)上，重癥組早期添加丙氨酰谷氨酰胺（1.5ml/kg.d）強(qiáng)化的腸外營養(yǎng)液治療，常規(guī)治療7d，兩組患兒術(shù)前、術(shù)后7d分別抽外周靜脈血5ml，應(yīng)用聚合酶鏈反應(yīng)（PCR）定性檢測(cè)患兒全血細(xì)菌DNA（細(xì)菌共有的16SrRNA、大腸桿菌BG）；采用密度梯度離心法分離出單個(gè)核細(xì)胞(MNC)，加入抗CD3、CD4、CD8單抗，用流式細(xì)胞儀檢測(cè)T（CD3+），Th（CD3+CD4+）,Ts(CD3+CD8+）,Th/Ts( CD4+/CD8+）；同時(shí)監(jiān)測(cè)血系列及觀察患者術(shù)后并發(fā)癥、胃腸道功能、肝功及營養(yǎng)支持治療不良反應(yīng)等。 結(jié)果術(shù)前重癥組16SrRNA，BG陽性率均較普通組升高，術(shù)后7d，兩組16SrRNA陽性率，，BG陽性率水平接近；術(shù)前重癥組T（CD3+）、Th（CD3+CD4+）、Th/Ts（CD4+/ CD8+）水平較普通組明顯降低(P0.05)，術(shù)后7d,兩組恢復(fù)正常，無統(tǒng)計(jì)學(xué)差異(P0.05)；術(shù)前重癥組Ts(CD3+CD8+）較普通組降低，無統(tǒng)計(jì)學(xué)差異(P0.05)，術(shù)后7d,兩組水平接近；術(shù)前白細(xì)胞及C反應(yīng)蛋白均較正常水平升高，術(shù)后7d兩組白細(xì)胞均恢復(fù)正常，重癥組CRP較普通組降低水平更為明顯(P0.05)；肝功及腎功術(shù)前術(shù)后均無明顯差異(P0.05)。 結(jié)論丙氨酰谷氨酰胺強(qiáng)化的腸外營養(yǎng)液術(shù)后早期干預(yù)小兒重癥闌尾炎，對(duì)細(xì)菌移位具有防治作用，可減輕腸粘膜損害，增強(qiáng)機(jī)體免疫促進(jìn)術(shù)后恢復(fù)，簡(jiǎn)單實(shí)用并發(fā)癥少。
[Abstract]:Objective to investigate the changes of immune function induced by bacterial translocation in children with severe appendicitis and the early intervention of alanyl glutamine fortified parenteral nutrition solution. Methods the children were divided into two groups according to the severity of the disease. Acute suppurative appendicitis with perforation combined with generalized peritonitis, intestinal obstruction, multiple abscesses in abdominal cavity or early septic shock were used as severe group. Acute suppurative appendicitis combined with localized peritonitis was treated with parenteral nutrition solution of 1.5 ml / kg 路d of alanyl glutamine in severe group on the basis of receiving antibiotics of the same grade. Routine treatment for 7 days, two groups of children before operation, On the 7th day after operation, peripheral venous blood was drawn from 5 ml, and the bacterial DNA (16s rRNA, Escherichia coli BGN) was qualitatively detected by polymerase chain reaction (PCR), and the mononuclear cells (MNCX) were isolated by density gradient centrifugation and added anti-CD3 + CD4 + CD8 monoclonal antibody. Flow cytometry was used to detect the TsT / T / T / T / T (CD4 / CD 8) CD8, and to observe the postoperative complications, gastrointestinal function, liver function and adverse effects of nutrition support. Results the positive rate of 16s rRNA CD4 in the severe group was higher than that in the normal group before operation, and the positive rate of 16s rRNA in the two groups was close to that in the control group at 7 days after operation, and the level of Thr / Tstsmb CD4 / CD8 in the preoperative severe group was significantly lower than that in the normal group, and recovered to normal on the 7th day after operation, and the positive rate of 16s rRNA in the severe group was higher than that in the normal group. There was no significant difference in Ts(CD3 CD8 between the two groups (P 0.05), but there was no significant difference between the two groups on the 7th day after operation, the levels of WBC and C-reactive protein in the two groups were higher than those in the normal group, and the white blood cells returned to normal at 7 days after operation. The level of CRP in severe group was significantly lower than that in normal group (P 0.05), and there was no significant difference in liver function and renal function before and after operation. Conclusion early intervention of alanyl-glutamine enhanced parenteral nutrition solution in children with severe appendicitis can prevent and cure bacterial translocation, reduce intestinal mucosal damage, enhance body immunity and promote postoperative recovery, with few simple and practical complications.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R726.5

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