早期肠内营养对肝脏“二次打击”的保护作用

Protective effects of early enteral nutrition on ＂two-hit＂ to liver

危重感染、缺血、缺氧等因素会对肝脏等腹腔脏器直接造成严重的病理创伤，即为肝脏第一次打击，在机体内造成了全身性非感染性炎症反应的易发环境，“第二次打击”即是在单核及巨噬细胞激活阶段的二次创伤，此时的任何不利因素或额外刺激都会启动促炎因子的链式反应。肠道是应激反应的中心器官，由于肠道机械、免疫、内分泌、生物屏障的破坏等因素，肝脏受到“二次打击”的序惯性损伤。早期肠内营养（EEN）不仅符合生理，而且可能通过减轻创伤应激反应程度、阻止细菌内毒素移位、促进肠肝循环、胃肠道激素分泌与免疫球蛋白的释放等机制减轻二次打击的危害，进而保护肝功能。EEN的正确使用改变了对某些疾病的治疗模式，但其应用时间、营养液的配比等具体问题还待进一步研究。

The critical infection, ischemia, and hypo-oxygenic state of the body can cause the first hit on liver and other abdominal organs, create the easily contaminated environment in the body. second hit is the second injury in the phase of monocyte macrophage call actival. Any negative impact can initiale the chain reaction of inflammatory factor the intestine is the center organ with the stress. Furthermore, the liver could get the second hit by mechanical, immuneological, bio-barrier demolishment and endocrine function inbalance of the small bowel, which results in the liver function deteriorated. Earlyenteral nutrition（EEN） is fit for physiology, and can protect liver from ＂two-hit＂ injury by mitigating the stress to injury, ceasing the endotoxin translocation, increasing the enterohepatic circulation, stimulating the secretion of the gastrointestinal hormone and enhancing the immunogloblin secretion. The correct use of the EEN changed the method of the treat-mcnt of diseases. But the time and ratio of the enteral nutrition for EEN still need further investigation.