肠内输入高渗盐糖溶液对严重烧伤犬肠黏膜屏障及脏器功能的影响

Influence of enteral administration of hypertonic electrolyte glucose solution on the intestinal barrier and organ functions in dogs with severe burn

目的了解烧伤犬休克期经肠道补充高渗盐糖溶液（HEGS）进行复苏后，肠道屏障及脏器功能的变化。方法将24只35％TBSAⅢ度烧伤犬按随机数字表法分为不补液（NF）组、静脉等渗补液（II）组、肠内等渗补液（EI）组和肠内高渗补液（EH）组，每组6只。2个等渗补液组于伤后30rain分别通过静脉或肠道给予含50g／L葡萄糖的生理盐水，24h补液量为4mL·kg^-1·％TBSA^-1（前8h匀速输入总量的一半，后16h匀速输入另一半）；EH组经肠道输入HEGS（含18g／L氯化钠、50g／L葡萄糖），伤后24h内补液量为2mL·kg^-1·％TBSA^-1，补液方式同前。测定各组犬肝肾功能指标[血清ALT、心肌型肌酸激酶同工酶（CK—MB）活性及肌酐、尿素氮水平]、血清二胺氧化酶（DAO）活性以及伤后24h肠黏膜Na^＋-K^＋-ATP酶活性。结果各组犬血清ALT活性相近。3个补液组血肌酐、尿素氮水平普遍低于NF组；伤后2hCK—MB活性均明显升高，EH组伤后2～8h低于NF、II组。II、EI、EH组血清DAO活性于伤后4h或6h起逐渐降低，分别为（3．9±0．6）～（3．6±0．5）U／L、（4．8±0．4）～（2．8±0．8）U／L和（6．4±1．8）～（3．5±0．8）U／L，均显著低于NF组（12．5±0．4）～（9．7±1．1）U／L（EH组与NF组比较，伤后4、6、8、24ht值分别为10．25、12．44、17．99、16．21，P值均小于0．05）。伤后24h各组肠黏膜Na^＋-K^＋-ATP酶活性从高到低依次为II组、EH组、EI组、NF组（前3组与NF组比较，t值分别为10．09、8．32、4．96，F值为26．79，P值均小于0．05）。结论HEGS对烧伤休克犬的肠黏膜屏障无明显不良影响。与NF比较，HEGS能显著改善伤犬心、肝、肾功能；减少1／2补液量，能达到与肠内或静脉输入等渗盐糖溶液相似的复苏效果。

Objective To study the change in intestinal barrier and organ functions of burned dog after enteral administration of hypertonic electrolyte glucose solution （HEGS） in shock stage. Methods Twenty-four Beagle dogs inflicted with 35% TBSA full-thickness burn were divided into no-fluid group （NF）, intravenous infusion with isotonic electrolyte glucose solution （IEGS） group （II group） , enteral infusion with lEGS group （EI） , and enteral infusion with HEGS group （EH） according to the random number table, with 6 dogs in each group. Saline, containing 50 g/L glucose, was intravenously or enterally infused into dogs in II group and EI group respectively 0.5 hour post injury （PIH） for resuscitation. Total infusion volume within PIH 24 was 4 mL·kg^-1·%TBSA^-1 （ half of the total volume was infused in the first 8 hours in a constant speed, the other half volume was infused in the rest 16 hours in a constant speed）. HEGS, containing 18 g/L NaCl and 50 g/L glucose, was enterally infused into dogs in EH group. Total infusion volume within PIH24 was2 mL·kg^-1·%TBSA^-1, with the same infusion speed as that in II and EI groups. Liver and kidney function indexes [ activity of ALT and CK-MB, expression levels of creatinine and blood u- rea nitrogen （BUN） in serum] , activity of diamine oxidase （DAO） , and activity of Na^＋-K^＋-ATP ase in intestinal mucosa at PIH 24 were determined. Results ALT activity in each group was close to one another. Serum levels of creatinine and BUN in II, EI, and EH groups were significantly lower than those in NF group. CK-MB activity obviously increased at PIH 2 in every group. CK-MB activity in EH group at PIH 2 to 8 was respectively lower than that in NF and lI groups. DAO activity in serum in II, El, and EH groups decreased since PIH 4 or PIH 6, respectively from （3.9 ±0.6） U/L to （3.6 ±0.5） U/L, （4.8 ±0.4） U/L to （2.8±0.8） U/L, （6.4±1.8） U/L to （3.5 ±0.8） U/L, all were significantly lower than those in NF group [ from （12.5 ±0.4） U/L to （9.7 ± 1.1 ） U/L, comparison between EH group and NF group, t value atPIH4, 6, 8, 24 was respectively 10.25, 12.44, 17.99, 16.21,Pvalues all below0.05]. The order of Na^＋-K^＋-ATP ase activity in intestinal mucosa at PIH 24 in each group from high to low was II group, EH group, EI group, and NF group （ comparison between former 3 groups and NF group, t value was respectively 10.09, 4.96, 8.32, F value was 26.79, P values all below 0.05）. Conclusions HEGS does not cause significant harm to the barrier function of intestinal mucosa of shock dog after burn. Compared with NF, HEGS can significantly improve functions of heart, liver, and kidney, and it can achieve the same resuscitation effect as enteral or intravenous infusion of lEGS with only half of the solution volume.