胃肠道手术后早期肠内营养对肠通透性的影响

Effects of Gastrointestinal Postoperative Early Enteral Nutrition on the Intestinal Barrier Function

目的:观察早期肠内营养(EEN)对胃肠道手术后肠屏障功能的影响。方法:采用前瞻、随机、双盲对照方法,选取60例胃肠道大手术患者,其中30例术后第3～5天起应用肠内营养(EN)粉剂作实验组,另外30例术后第3天起2周内应用全肠外营养(TPN)作为对照组。两组患者分别予以等氮、等热卡营养支持。术后3d、7d和14d分别给予肠通透性测试液(内含乳果糖2g,甘露醇1g),留取6h尿液,并且于手术前1d、手术后4d和8d晨分别抽取血。采用液相色谱串联质谱法测定尿中乳果糖(L)和甘露醇(M)的浓度,用MB-80微生物动态检测系统和EKT-5Mset试剂盒检测两组患者血浆内毒素水平。结果:(1)肠通透性(L/M)对比:术后8d两组L/M比值较术后3d均升高,对照组明显高于实验组,但无显著性差异;术后14dL/M比值对照组明显高于实验组,两组有显著性差异(P<0.01),对照组术后3d和8d之间有明显差异(P<0.05)。(2)血浆内毒素水平:术后4d较术前1d两组血浆内毒素均有所升高,但无显著性差别;术后7d对照组血浆内毒素呈逐渐升高趋势,实验组血浆内毒素呈逐渐下降趋势,两组间对比有显著性差别(P<0.01)。结论:创伤应激早期肠粘膜通透会有明显升高,肠内营养有较好维护肠粘膜屏障功能的作用,早期EN有助于维持肠屏障结构和功能,纠正肠道菌群失调,从而降低内毒素血症。

Objective：To observe the effect of early enteral nutrition （EEN） on intestinal barrier function after the gastrointestinal surgery. Methods： Using of prospective, randomized, double-blind and controlled method, sixty patients received gastrointestinal operations were randomly divided into two groups （30 for each）. The experimental group received enteral nutrition 3-5 days after the operation and the control group received total parenteral nutrition（TPN） 3 days after the operation. The patients were administered with the above nutrients that contained equal energy and equal amount of nitrogen. After 3 d, 7 d and 14 d, respectively, patients were administered intestinal permeability test solution （contained 2 g lactulose and 1g mannitol）. Six hours urine was collected and determined the urinary lactulose and mannitol concentration by LC-MS/MS method. Blood samples were collected 1 day before the operation and 1, 4 and 8 days postoperation to detect the plasma endotoxin level by using MB-80 Dynamic microbial system and EKT-5Mset Kit. Results： （1） L / M ratio in both two groups were higher at 8 d than at 3 d, and the ratios were higher in control group than in experimental group, but no significant difference was observed. After 14 d, the L / M ratio in control group was significantly higher than in experimental group （P〈0.01）. （2） After 7d the plasma endotoxin in control group was gradually increased, but gradually decreased in experimental group. No significant difference was observed between the two groups （P〈0.01）. Conclusion： Intestinal permeability will enhance because of traumatic stress early intestinal adhesion. Enteral nutrition can maintain the intestinal mucosal barrier function, EEN is beneficial to maintain intestinal barrier structure and function, balance intestinal flora, and consequently reduce endotoxemia.