烧伤大鼠肠黏膜损伤肠内营养实施时机的选择
The implementation timing of enteral nutrition and its impact on intestinal mucosa damage in burned rats
-
摘要: 目的:探索大鼠烧伤后最佳的肠内营养(EN)实施时机,观察早期肠内营养(EEN)对烧伤后肠黏膜损伤的影响。方法:采用30%总体表面积Ⅲ度烧伤大鼠模型,将88只Wistar大鼠随机分为假伤对照组(C组)8只,早期肠内营养组(EEN组,于伤后6 h开始实施EN)和延迟肠内营养组(DEN组,于伤后24 h开始实施EN)各40只(每时相点8只)。检测伤前和烧伤后0.5、1、3、7和10 d大鼠肠黏膜跨膜电位差(PD)、肠黏膜血流量(IMBF)、肠黏膜内pH(pHi)值、血浆内毒素(LPS)含量和二胺氧化酶(DAO)活性,并计算肠黏膜损伤指数。结果:EEN组和DEN组大鼠烧伤后天数(PBD)0.5～10肠黏膜PD、IMBF和空肠pHi值均低于C组(PBD 0)(P<0.01),而血浆LPS含量、DAO活性及肠黏膜损伤指数均高于C组(P<0.05～P<0.01)。EEN组大鼠PBD 1～10肠黏膜PD、IMBF和PBD 1、PBD 3、PBD 10空肠pHi值均高于DEN组(P<0.05～P<0.01),而PBD 3～10 LPS及PBD 3血浆DAO活性均低于DEN组(P<0.01)。EEN组与DEN组比较,未出现明显的不适症状,未见呕吐、腹胀与腹泻。结论:较早给予EN能改善烧伤后肠黏膜血供,减轻肠道受损程度,维护肠黏膜结构与功能,未见明显不良反应。Abstract: Objective:To investigate the best time of enteral nutrition(EN),and observe the effects of early enteral nutrition(EEN) on intestinal mucosa damage after burn injury.Methods:Rats were inflicted with 30% total body surface area full-thickness burn.Eighty-eight Wistar rats were randomly divided into the sham burn control group(C group),early enteral nutrition group(EEN group,in which enteral nutrition was given at the sixth hour after burn) and delayed enteral nutrition group(DEN group,in which enteral nutrition began at the 24th hour after burn).The intestinal mucosal potential difference(PD),intestinal mucosal blood flow(IMBF),jejunum pH(pHi),level of plasma lipopolysaccharide(LPS),diamine oxidase(DAO) activity and intestinal mucosa damage index in all rats were detected before burn and at postburn 0.5,1,3,7 and 10 days(PBD).Results:After burn injury,compared with C group,the levels of PD,IMBF and pHi in burned rats were markedly decreased(P<0.01),while the LPS content,DAO activity and mucosa damage index were significantly increased(P<0.05 to P<0.01).Compared with DEN group,the PD and IMBF at PBD 1 to 10 and pHi at PBD 1,PBD 3,PBD 10 in EEN group were significantly high(P<0.05 to P<0.01),but the LPS content at PBD 3 to 10 and DAO activity at PBD 3 were obviously low in EEN group(P<0.01).No apparent discomfort,such as vomit,abdominal distension and diarrhea in two groups were found.Conclusions:Early enteral nutrition can improve the intestinal mucosal blood flow,reduce the intestinal damage,and maintain the structure and function of intestinal mucosa after burn injury.
-
Key words:
- burn /
- enteral nutrition /
- intestinal mucosal blood flow /
- intestinal injury /
- rats
-
[1] 汪仕良,邓诗琳.烧伤代谢营养学[M].石家庄:河北科技出版社,2009:32-41. [2] 吴修文,王焕,吴炜,等.重组人肠三叶因子减轻烧伤后肠源性高代谢的实验研究[J].重庆医学,2012,41(15):1465-1470. [3] Qi ZD,Chi Q.Intestinal dysfunction and enteral nutrition[J].Chin J Gastrointest Surg,2012,15(5):530-532. [4] Guo G,Bai X,Cai C,et al.The protective effect of different enteral nutrition combined with growth hormone on intestinal mucosal damage of scalded rats[J].Burns,2010,36(8):1283-1288. [5] Tuna M,Latifi R,El-Menyar A,et al.Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients:indications,techniques,and complications[J].Eur J Trauma Emerg Surg,2013,39(3):235-242. [6] Hosoda N,Nishi M,Nakagawa M,et al.Structural and functional alterations in the gut of parenterally or enterally fed rats[J].J Surg Res,1989,47(2):129-133. [7] 车晋伟,胡森,吴静,等.烧伤休克犬肠黏膜血流量动态监测方法的研究[J].感染、炎症、修复,2008,9(1):15-17. [8] 贺立新,郭振荣.烧伤休克期复苏:回顾与进展[J/CD].中华临床医师杂志:电子版,2012,6(18):5389-5392. [9] Liu DT,Brown DC,Silverstein DC.Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis:a retrospective study of 45 cases(2000-2009)[J].J Vet Emerg Crit Care,2012,22(4):453-459. [10] 曹瑞芬,张育才,张宇鸣.严重感染及脓毒性休克时胃肠损害的研究进展[J].中华儿科杂志,2008,46(2):154-157. [11] 周锐华,鄢文海.危重烧伤应激反应与研究现状[J].感染、炎症、修复,2006,7(1):50-52. [12] Fan J,Meng QY,Guo GH,et al.Effects of early enteral nutrition supplemented with arginine on intestinal mucosal immunity in severely burned mice[J].Clin Nutr,2010,29(1):124-130. [13] Kreymann KG,Berger MM,Deutz NE,et al.ESPEN Guidelines on Enteral Nutrition:Intensive care[J].Clin Nutr,2006,25(2):210-223. [14] 蔡浩,李文婷,朱家源,等.重度烧伤患者肠内早期营养支持的临床研究[J].中外医学研究,2011,9(35):12-13. [15] Lu G,Huang J,Yu J,et al.Influence of early post-burn enteral nutrition on clinical outcomes of patients with extensive burns[J].J Clin Biochem Nutr,2011,48(3):222-225. -
点击查看大图
计量
- 文章访问数: 2846
- HTML全文浏览量: 323
- PDF下载量: 112
- 被引次数: 0
下载:
