重症急性胰腺炎肠黏膜屏障损伤机制与临床治疗进展

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1、目录1.中文摘要„„„„„„„„„„„„„„„„„„„„„„„„„„„22.英文摘要„„„„„„„„„„„„„„„„„„„„„„„„„„„33.正文„„„„„„„„„„„„„„„„„„„„„„„„„„„„„54.小结„„„„„„„„„„„„„„„„„„„„„„„„„„„„„145.参考文献„„„„„„„„„„„„„„„„„„„„„„„„„„„166.致谢„„„„„„„„„„„„„„„„„„„„„„„„„„„„„217.附录A英中文术语缩略语对照表„„„„„„„„„„„„„„„„„228.附录B个人简历„„„„„„„„„

2、„„„„„„„„„„„„„„„231重症急性胰腺炎肠黏膜屏障损伤机制与临床治疗进展中文摘要【摘要】重症急性胰腺炎(SAP)是一种常见的临床急腹症，发病急，死亡率高。SAP发生后，严重的炎症反应及大量液体渗出丢失会造成机体缺血缺氧、缺氧再灌注损伤，各种炎症介质和细胞因子互相激活释放形成级联反应，造成肠黏膜屏障功能障碍（IBFD），并在广泛大量应用广谱抗生素以及长期禁食和肠外营养的基础上发生致病菌繁殖，细菌移位（BT）和内毒素血症。各种有害物质随血流释放至全身各系统、各器官，发挥出互相促进、互相影响的网络样致病效应，进而并

3、发败血症及全身炎症反应综合症（SIRS），对胰腺及其它脏器造成严重的“二次打击”。甚至造成多系统、多器官损害，诱发和（或）加重多器官障碍综合征（MODS），最终导致多器官脏器功能衰竭（MSOF）而死亡。在SAP疾病的进展过程中，肠道不仅是MSOF的靶器官，更是启动者，因此肠黏膜屏障功能的损害在此连锁反应中是起始和关键环节，如能阻断这一环节，给予肠黏膜屏障功能的适时和有效防护，对降低SAP患者病死率起着极其关键的作用。临床上，寻找肠黏膜保护的方法不能通过某一种或几种物质，随着人们对肠黏膜屏障损伤机制的深入了解，物质间的联

4、合作用对肠黏膜屏障功能的影响将会是今后的研究热点。本文将对重症急性胰腺炎疾病发展过程中肠黏膜屏障损伤的机制以及临床治疗进展作一概述。【关键词】重症急性胰腺炎（SAP）；肠屏障功能障碍（IBFD）；细菌移位（BT）；缺血缺氧；炎症介质；全身炎症反应综合症（SIRS）；多器官脏器功能衰竭（MSOF）。2IntestinalmucosalbarrierinjurymechanismandclinicaltreatmentprogressofsevereacutepancreatitisAbstract【abstract】Se

5、vereacutepancreatitis(SAP)isacommonacuteabdomeninclinicwitharapidonsetanddangerouspathogeneticcondition.Assapoccurred,severeinflammatoryresponseandalargenumberofliquidexudationwillbringthebodyaboutaninjuryofintestinalmucosabarrierbythefactorsofischemiaandhypoxia

6、、ischemia-reperfusion(IR)injury、acascadereactionformedbyavarietyofinflammatorymediatorsandcytokinesactivateandreleaseandthenbringabouttheincreaseofintestinalpermeability,evenbacterialtranslocation(BT)andendotoxemiaonthebasisoftheextensiveapplicationofbroad-spect

7、rumantibioticsaswellaslong-termfastingandparenteralnutrition.Avarietyofharmfulsubstancesreleasedwiththebloodflowtothebodysystems、organs,playaNetwork-likepathogeniceffectwhichpromoteandinfluenceeachother,complicatedbysepsisandsystemicinflammatoryresponsesyndrome(

8、SIRS),causingserious―second-strike‖topancreasandotherorgans.Eventocausemulti-system,multi-organdamage,induceand(or)increasethemultipleorgandysfunctionsyndrome(MODS),e