过渡肠内营养对家兔重症急性胰腺炎血液流变学及炎症因子的影响

Effects of combined enteral nutrition support on hemorrheologic parameters and the level of inflammatory factors in rabbits with severe acute pancreatitis

目的 观察不同营养支持模式对于重症急性胰腺炎的血液流变学、炎症因子水平的影响,探索重症急性胰腺炎（SAP）营养支持最佳模式.方法 将实验动物数字随机法分为3组：早期肠内营养组（EEN）：SAP后1 d开始肠内营养（EN）;过渡肠内营养组（CEN）：SAP制模后1、2 d静脉营养（PN）,3 d半量PN、半量EN,4 d后全量EN;肠外营养组：术后1 d开始全程PN;每组20只.在制模后1、3、7 d分别对实验动物进行血液流变学检查,制模后1、7 d进行炎症因子[白细胞介素（IL）-6、IL-8、肿瘤坏死因子（TNF）α]检测.结果 与其他两组相比,CEN组的红细胞沉降率、全血高切还原黏度、全血低切还原黏度等指标于模型制作后7d与1d比较均有显著降低（P〈0.05）[（14.85±3.08）比（21.99±3.89）mm/h;（7.97±1.23）比（9.72±2.42）mPas;（27.65±2.93）比（38.36±4.95）mPas].组内比较,CEN组模型制作后7 d全部血流流变学指标数值较1 d均显著降低.而EEN组除全血高切还原黏度和红细胞聚集指数两项指标外,PN组的全部血流流变学指标数值制模术后7 d与1 d相比组内无显著性下降.炎症因子表达水平比较,CEN组术后7 d的IL-8、TNF-α值均明显低于PN组,IL-8、IL-6表达水平术后7 d明显低于EEN组（P〈0.05）;组内比较,CEN组术后7 d IL-6、TNF-α的表达水平均明显低于术后1 d（P〈0.05）.结论 EEN除了降低炎症因子水平,EEN对SAP的调控机制还可能包括了通过改善血流动力学改变而实现的,恰当时机的EN可能是SAP的最佳营养支持治疗模式.

Objective To explore the effects of combined enteral nutrition （CEN） on the hemorheologic parameters and the changing levels of inflammatory factors in an animal model of severe acute pancreatitis （SAP）. Methods The experimental animals were divided randomly into 3 groups, i.e. early enteral nutrition （EEN） group, CEN group and parenteral nutrition（PN）group （n=20 each）. Enteral nutrition was administered to the EEN and CEN group animals at 24 h and 72 h post-modeling respectively. The PN group animals were supported by parenteral nutrition all time. Hemorrheologic indices of all experimental animals were examined on Days 1, 3 and 7 post-modeling. And the inflammatory factors were examined on Days 1 and 7. Results Compared with the EEN and PN groups, some hemorrheologic indices of the CEN group decreased significantly （P〈0.05） on Day 7 post-modeling. They included blood sedimentation, hematocrit （HCT）, whole blood high-cut reduction viscosity and whole blood low-cut reduction viscosity. As compared within the CEN group, each hemorrheologic index was lower on Day 7 than that on Day 1 （P〈0.05）. Except for whole blood high-cut reduction viscosity and erythrocyte aggregation index in the EEN group after a 7-day nutrition support, there was no significant change for all hemorrheologic indices in the PN group. As to the level of inflammatory factors, the values of interleukin 8 （IL-8） and tumor necrosis factor-α （TNF-α） in the CEN group were lower than those in the PN group on Day 7 post-modeling （P〈0.05）. The values of IL-8 and IL-6 in the CEN group were lower than those in the EEN group on the same day（P〈0.05）. As compared within the CEN group, the values of IL-6 and TNF-α were lower on Day 7 than those on Day 1 post-modeling （P〈0.05）. Conclusion The modulatory mechanism of EN over SAP should be achieved by correcting hemorrheologic index change and lowering the level of inflammatory factors. A proper timing of EN is probably the most optimal nutrition support mode of SAP therapy.