Izvorni znanstveni članak
Integrity of Gut Mucosa during Anaesthesia in Major Abdominal Surgery
Danijela Gulam
Branko Dmitrović
Slavica Kvolik
Jerko Barbić
Lada Zibar
Damir Kovačić
Sažetak
The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent patients during the
major open abdominal surgery which lasted from 2 to 7 hours. Two samples of the intestinal mucosa were removed: at
the beginning, and at the end of the surgical procedure in general anaesthesia. A mucosal injury was classified into 4
grades. pH, PCO2 and lactate level were measured in the blood samples from the arterial and mesenteric vein in one hour
time intervals. The changes of intestinal mucosa were found in 31 patients (51.7%): in 19 patients (31.7%) grade 1
changes were recorded, in 10 patients (16.7%) grade 2, and in 2 patients (3.3%) grade 3. Grade 4 lesions were not recorded.
There was a statistically significant correlation between grades of the mucosal damage and the surgery duration
(p=0.001). Analysis during the one hour intervals showed that there was no exact time point when the significant aggravation
of the pathohistological changes in intestinal mucosa occurred. However, when patients were allocated into two
subgroups with surgical procedures lasting less than 4 hours and more than 4 hours, there was a statistically significant
difference in the grades of mucosal damage between subgroups (p<0.05). More biopsies without pathohistological changes
were observed in the patients whose procedure duration was < 4 hours. A significantly higher lactate concentrations
in arterial and mesenteric venous blood were observed in the patients with pathohistological changes at 6 hours time
point as compared to 2 hour time point in the patients without pathohistological changes (p<0.05). During the open abdominal
surgery in general anaesthesia, the length of the procedure influences the grade of the intestinal mucosa injury.
Deterioration of the pathohistological findings in the intestinal mucosa correlates with high lactate blood level, suggesting
that the cause of these changes may result from tissue hypoxia.
Ključne riječi
intestinal mucosa; anaesthesia; abdominal surgery; anoxia
Hrčak ID:
69124
URI
Datum izdavanja:
24.6.2011.
Posjeta: 1.204 *