关键词：腹腔感染；肠黏膜；细菌易位

    摘要：目的 观察严重腹腔感染时肠黏膜的形态学变化，探讨严重腹腔感染早期肠黏膜病理损害与细菌易位的关系。 方法 SD大鼠60只，随机分成实验组和对照组，每组30只。实验组采用盲肠结扎加穿孔手术制作严重腹腔感染模型，对照组仅行单纯剖腹手术。于术后1、2、4 d每组取空肠、回肠组织，行常规病理检查和电镜下观察；心脏穿刺取血1 ml行血浆内毒素水平测定；取血2 ml作细菌培养。 结果 对照组空、回肠黏膜光镜、电镜下观察均未见异常。实验组光镜下可见空、回肠黏膜和黏膜下层间质水肿、血管充血，黏膜层有中性粒细胞浸润，肠绒毛毛细血管充血，部分区域有黏膜上皮脱落，浆膜层明显炎性渗出；电镜下可见肠上皮细胞微绒毛稀疏，排列不整齐，部分脱落，肠上皮细胞间紧密连接出现异常，结构松弛。实验组术后血浆内毒素水平较对照组升高5~12倍，术后1、2、4 d血细菌培养阳性率分别为20%、30%和10%，对照组血细菌培养均为阴性。 结论 严重腹腔感染早期出现肠黏膜病理损害，诱发肠道细菌和内毒素易位。

    Intestinal mucosal pathology in rats with severe abdominal infection

    LI Kun¹, WU Cheng-tang¹, ZHANG Jun-hua², ZHENG Yong-bo¹, LEI Shang-tong<sup>1

    1</sup>Department of General Surgery, ²Department of Operation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

    Abstract: Objective To observe the pathological changes of the intestinal mucosa in rats with severe abdominal infection. Method A total of 60 SD rats were divided randomly into control group and experimental group (n=30), and in the latter group, the rats underwent cecal ligation and puncture (CLP) while those in the former had only laparotomy. The jejunum and ileum were sampled on postoperative days 1, 2 and 4 for optical and electron microscopic observations. The positivity rate of blood bacterial culture and plasma level of endotoxin were determined in the rats. Results No abnormal changes were observed with either optical and electron microscope in the small intestinal mucous membrane of rats in the control group, but in rats of the experimental group, microscopic examination revealed interstitial edema, vascular engorgement and neutrophil infiltration in the small intestine mucous membrane and the submucosa, and electron microscopy demonstrated loose and disorderly arrangement of the microvilli of the intestinal epithelium. Plasma endotoxin level in rats in the experimental group was 5- to 12-fold higher than that in the control group. The positivity rates of blood bacteria culture were 20%, 30% and 10% on postoperative days 1, 2 and 4 respectively in the experimental group, but were all zero in the control group. Conclusion Pathologic lesions in the intestinal mucosa occur during the early stage of severe abdominal infection in rats as the result of bacteria and endotoxin translocation. ......