体外循环术后肠道微生态失衡与胃肠道功能损伤的关系分析

    Relationship between intestinal microecological imbalance and gastrointestinal functional injury following cardiopulmonary bypass surgery

      摘要
    • 摘要:
      目的 分析体外循环术后患者肠道微生态变化，并探讨其与胃肠道功能损伤的关系。
      方法  选取2023年3月～2024年6月于院内行体外循环术的患者151例，根据术后7 d内是否发生胃肠道功能损伤分为无损伤组（n=121）和损伤组（n=30）。比较两组术前、术后肠道菌群的相对丰度及多样性；比较不同胃肠功能损伤分级患者肠道菌群相对丰度及多样性；Spearman相关性分析法分析体外循环术后患者肠道菌群相对丰度、多样性与胃肠道功能损伤的相关性。
      结果  术后7 d，151例行体外循环术的患者中有19.87%发生胃肠道功能损伤，其中I级、Ⅱ级、Ⅲ级分别13例、11例、6例；与无损伤组比较，损伤组患者体外循环（CPB）时间长（P<0.05），术后住院时间长（P<0.01）；术前两组肠杆菌科、肠球菌属、葡萄球菌属、梭菌属、乳杆菌属、双歧杆菌属以及Shannon指数、Simpson指数比较，差异均无统计学意义；与术后无损伤组比较以及与本组术前比较，肠杆菌科（P<0.05）、肠球菌属（P<0.05）、梭菌属（P<0.01）、葡萄球菌属（P<0.05）相对丰度均升高，乳杆菌属（P<0.01）相对丰度、双歧杆菌属（P<0.05）相对丰度、Shannon指数（P<0.05）、Simpson指数（P<0.01）均降低。Spearman相关性分析显示，肠杆菌科、肠球菌属、梭菌属、葡萄球菌属相对丰度与胃肠道功能损伤分级为正相关（均P<0.01），乳杆菌属、双歧杆菌属相对丰度及Shannon指数、Simpson指数与胃肠道功能损伤分级为负相关（均P<0.01）。
      结论 体外循环术后患者肠道微生态失衡与胃肠道功能损伤的发生及严重程度密切相关。

       

      Abstract:
      AIM To investigate the changes in intestinal microecology in patients following cardiopulmonary bypass surgery (CPB) and to examine the association between these changes and gastrointestinal functional injury (GFI).
      METHODS  This study included 151 patients who underwent CPB at our hospital from March 2023 to June 2024. Within seven days post-surgery, patients were categorized into an injury group and a non-injury group based on the presence of GFI. The relative abundance and diversity of intestinal flora were compared between the two groups before and after surgery. Additionally, comparisons were made among patients with different grades of GFI. Spearman’s correlation analysis was used to assess the relationship between the relative abundance and diversity of intestinal flora and GFI following CPB.
      RESULTS Seven days after surgery, 19.87% of the 151 patients who underwent extracorporeal circulation surgery experienced gastrointestinal dysfunction, including 13 cases of grade I, 11 cases of grade II, and 6 cases of grade III, respectively; Compared with the non-invasive group, patients in the injury group had longer cardiopulmonary bypass (CPB) time (P<0.05) and longer postoperative hospitalization time (P<0.01); There was no statistically significant difference in the preoperative comparison of Enterobacteriaceae, Enterococcus, Staphylococcus, Clostridium, Lactobacillus, Bifidobacterium, Shannon index, Simpson index between the two groups; Compared with the postoperative non-invasive group and the preoperative group, the relative abundance of Enterobacteriaceae (P<0.05), Enterococcus (P<0.05), Clostridium (P<0.01), and Staphylococcus (P<0.05) increased, while the relative abundance of Lactobacillus (P<0.01), Bifidobacterium (P<0.05), Shannon index (P<0.05), and Simpson index (P<0.01) decreased. Spearman correlation analysis showed that the relative abundance of Enterobacteriaceae, Enterococcus, Clostridium, and Staphylococcus was positively correlated with the grading of gastrointestinal functional injury (all P<0.01), while the relative abundance of Lactobacillus, Bifidobacterium, Shannon index, Simpson index were negatively correlated with the grading of gastrointestinal functional injury (all P<0.01).
      CONCLUSION  Intestinal microecological imbalance in patients following CPB is closely associated with the incidence and severity of GFI.

       

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