Effects of preoperatively selected gut decontamination on cardiopulmonary bypass-induced endotoxemia.
OBJECTIVE
To evaluate the influence of preoperatively selected gut decontamination (SGD) on intestinally derived endotoxemia(ETM) in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulmonary bypass(CPB).


METHODS
Thirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i.e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 mg garlicin and 20% Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levels of endotoxin, D-lactate, TNF-alpha and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded.


RESULTS
Aerobic gram-negative bacilli (AGNB) ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group (P less than 0.05). The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB (P less than 0.05). Endotoxin levels of patients in both groups elevated significantly after CPB (P less than 0.05), and endotoxin levels of the patients in SGD group decreased significantly at points of CPB end (P less than 0.01) and 24 h after CPB (P less than 0.05) compared with those in control group. The levels of TNF-alpha and complement 3 were similar in both groups as well as clinical and biochemical markers.


CONCLUSIONS
CPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.
Yu
Jiang
J
Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. yujiang1997@163.com
Xiao
Ying-Bin
YB
Wang
Xian-Yuan
XY
D000328:Adult; D000498:Allyl Compounds / Q000627:therapeutic use; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003666:Decontamination; D004220:Disulfides / Q000627:therapeutic use; D019446:Endotoxemia / Q000517:prevention & control*; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D011300:Preoperative Care; D012214:Rheumatic Heart Disease / Q000601:surgery; D014031:Tobramycin / Q000627:therapeutic use
D000498:Allyl Compounds; D004220:Disulfides; C028009:diallyl disulfide; D014031:Tobramycin