早期肠内营养联合肠道去污对犬急性坏死性胰腺炎炎症反应的影响

Effect of early enteral nutrition and selective decontamination of the digestive tract on the systemic inflammatory response in dogs with acute necrotizing pancreatitis

目的观察早期肠内营养(EN)联合肠道去污(SDD)对犬急性坏死性胰腺炎(ANP)内毒素移位及全身炎症反应的影响。方法在麻醉状态下,经腹向胰管内注入5%牛磺胆酸钠混合液(1ml/kg)诱导ANP。造模后,20条杂种犬分为生理盐水(NS)组(n=5)、EN组(n=5)、SDD组(n=5)和早期肠内营养联合肠道去污(ESDD)组(n=5)。在造模后第1、2、3、4、5天测定外周血淀粉酶、乳酸脱氢酶、肿瘤坏死因子(TNF)α、白细胞介素(IL1)β和内毒素的含量。实验第7天处死动物并收集标本。取胰腺组织置于中性甲醛和液氮中保存,行HE染色观察其组织病理学改变并检测中性粒细胞髓过氧化物酶(MPO)活性。结果各组中淀粉酶、乳酸脱氢酶均差异无统计学意义,胰腺病理无明显差异,胰腺组织内的MPO虽然在NS组高于其他各组,但各组之间差异无统计学意义(P>0.05)。内毒素在第2天后NS组明显高于SDD、EN、ESDD组(P<0.05),TNFα、IL1β在前3天各组均无明显差异(P>0.05),在第4、5天时NS组明显高于SDD、EN、ESDD组(P<0.05),ESDD组TNFα、IL1β水平均低于SDD、EN组,但SDD、EN、ESDD组之间无明显差异(P>0.05)。结论SDD、EN或ESDD均不能改善犬ANP胰腺组织自身的炎症,但SDD、EN、ESDD能明显减少犬ANP后期血液中的内毒素、TNFα、IL1β水平,改善全身炎症反应综合征,其中ESDD治疗效果最佳。

Objective To evaluate the effect of early enteral nutrition(EN) and selective decontamination of the digestive tract(SDD) on the endotoxin translocation and systemic inflammatory response syndrome in dogs with acute necrotizing pancreatitis(ANP). Methods ANP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and trypsin into the pancreatic duct. Twenty experimental dogs were divided into 4 groups, normal control saline(NS) group, SDD group, EN group, EN combined with SDD(ESDD) group. The levels of amylase, lactic dehydrogenase, interleukin-1β(IL-1β), tumor necrosis factor-α (TNF-α) and endotoxin in the peripheral plasma were measured every day. Specimens of tissue from pancreas were taked at the 7th day. The activity of PMN myeloperoxidase (MPO) in pancreas was determined by zymohistochemistry. Results There was no significant difference in the levels of amylase and lactic dehydrogenase in the peripheral plasma among the groups (P>0.05). The pathologic feature of pancreas had no significant differnece(P>0.05). The levels of endotoxin in SDD group, EEN group and ESDD group were significantly decreased than that in NS group after the second day (P<0.05). The levels of IL-1β, TNF-α in SDD group, EN group and ESDD group were significantly decreased than those in NS group on the 4th and the 5th day(P<0.05). Conclusions EN, SDD and ESDD could not decrease the pancreatic inflammatory, but they could significantly decrease the endoxin translocation and systemic inflammatory response in ANP. ESDD has the best effect among treatment group.