摘要
目的研究肠道缺血再灌注损伤时肠淋巴干结扎和含谷氨酰胺的肠内营养对肠道及远隔组织的影响。方法 40只SD大鼠胃造瘘后随机分为:假手术组、普通肠内营养组、普通肠内营养+肠淋巴干结扎组、谷氨酰胺组及谷氨酰胺+肠淋巴干结扎组,每组8只。除假手术组外,其余4组大鼠行7 d肠内营养干预后开腹夹闭肠系膜上动脉60 min,2个结扎组同时进行淋巴干结扎;假手术组行普通饮食7 d后开腹60 min后关腹。所有大鼠术后继续原营养3 d。于再灌注前1 d、再灌注后1 d及3 d测定肠道通透性,在再灌注后3 d观察肠壁形态学改变,检测血清中内毒素、D-乳酸、二胺氧化酶水平及肺组织细胞凋亡指数。结果再灌注后1 d时,各组肠道通透性均比再灌注前明显增加(P<0.05);再灌注后3 d时与再灌注后1 d比较,2个结扎组的肠道通透性均明显降低(P<0.05)。谷氨酰胺+肠淋巴干结扎组回肠和空肠的黏膜厚度及回肠的绒毛高度明显高于其余4组(P<0.05),谷氨酰胺组回肠的绒毛高度明显高于普通肠内营养组(P<0.05);普通肠内营养+肠淋巴干结扎组肠壁各形态学指标均高于普通肠内营养组,但差异无统计学意义(P>0.05)。肠淋巴干结扎组的肺组织细胞凋亡指数明显低于未结扎组(P<0.05),内毒素、D-乳酸及二胺氧化酶水平较未结扎组有下降趋势,但差异无统计学意义(P>0.05)。结论大鼠肠道缺血再灌注损伤引起肠道通透性增加、细菌内毒素移位和系统炎症反应,肠淋巴管结扎和谷氨酰胺肠内营养干预可以弱化肺组织损伤,增加肠黏膜的厚度,维护肠屏障功能,减少内毒素移位,降低血中内毒素水平,减轻系统炎症反应。含谷氨酰胺的肠内营养效果优于普通肠内营养。
Objective To investigate the effect of mesenteric lymphatic duct liagtion and glutamine enteral nutrition on intestine and distant organs in intestinal ischemia/reperfusion injury.Methods Forty male SD rats undergoing gastrostomy were randomly assigned into 5 groups(n=8): sham operation group,normal enteral nutrition group,normal enteral nutrition+lymphatic duct ligation group,glutamine group and glutamine+lymphatic duct ligation group.Sham operation group only received laparotomy after 7 days of full diet,the other four groups were subjected to 60 min of intestinal ischemia after 7 days of enteral nutrition,and the two lymphatic duct ligation groups were plus mesenteric lymphatic duct ligation.The original nutrition continued 3 days after reperfusion.Intestinal permeability was detected on day 1 before reperfusion,day 1 and 3 after reperfusion.Intestinal morphology was observed,endotoxin,D-lactate and diamine oxidase levels in serum,and apoptotic index in lung tissue were detected on day 3 after reperfusion.Results The intestinal permeability in each group was significantly increased on day 1 after reperfusion(P〈0.05),and which in normal enteral nutrition+lymphatic duct ligation group and glutamine+lymphatic duct ligation group were significantly decreased on day 3 after reperfusion(P〈0.05).The mucosal thickness and villus height of ileum and mucosal thickness of jejunium in glutamine+lymphatic duct ligation group were significantly higher than those in other groups(P〈0.05),and villus height of ileum in glutamine group was higher than that in normal enteral nutrition group(P〈0.05);those morphology indexes in normal enteral nutrition+lymphatic duct ligation group were higher than those in normal enteral nutrition group,but there was no statistical signification(P〈0.05).Apoptosis index of lung tissue in lymphatic duct ligation groups was significant lower than that in no-ligation groups(P〈0.05).Levels of endotoxin,D-lactate,and diamine oxidase in lymphatic duct ligation groups had downward trends compared with no-ligation groups,but there was no statistical signification(P〈0.05).Conclusions Intestinal ischemia/reperfusion injury of rats can cause intestinal permeability increase,bacterial endotoxin translocation and systemic inflammatory response.Mesenteric lymphatic duct ligation and glutamine enteral nutrition intervention can weak lung tissue damage,increase thickness of intestinal mucosa,maintain intestinal barrier function,reduce endotoxin translocation and attenuate systemic inflammatory response.Enteral nutrition with glutamine was better than normal enteral nutrition.
出处
《中国普外基础与临床杂志》
CAS
2010年第5期443-448,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
国家自然科学基金资助项目(项目编号:30471707)~~
关键词
肠道缺血再灌注
肠淋巴干结扎
谷氨酰胺
肠内营养
Intestinal ischemia/reperfusion
Mesenteric lymphatic duct ligation
Glutamine
Enteral nutrition