门静脉途径胃肠外营养的实验研究

Experimental study on parenteral nutrition via protal vein

利用脾切除术后狗的实验模型进行门静脉途径胃肠外营养(PN)可行性及营养支持效果的实验研究。23只狗随机分为两组。12只狗进行门静脉途径PN(PN—pv组),11只狗进行中心静脉途径PN(PN—cv)。手术后第1天起两组给予7天相同的营养支持(总热量60kc al·kg/d,氮0.384g·kg/d,葡萄糖6.3S·kg/d,脂肪2.8g·kg/d,非蛋白热量/氮=131.25)。7天后,PN-pv组TIBC明显高于PN-cv组且显著高于术前水平。PN-pv组术后第2、4、8天血糖显著低于PN-cv组。术后第4、8天,PN-pv组血浆缬氨酸,亮氨酸及异亮氨酸水平显著高于PN-cv,且两组均显著高于术前水平:PN-pv组,术后第3、7天尿3-甲基组氨酸排出量显著低于PN-cv组。肝脏组织学检查结果:PN-cv组发生肝细胞内淤胆6例,PN-pv组无一例发生。研究表明短期门静脉途径胃肠外营养是可行的。且效果优于中心静脉途径并可避免肝胆系统淤胆。

The feasibility of parentcral nutrition via portal vein and the relative efficacy of portal and central venous infusion of PN were evaluated in a splenectomized dog model. Twenty three dogs were divided randomly into two groups. 12 dogs received PN via portal vein and 11 dogs received PN via central vein. The same nutritional support (60 kcal/kg/day , nitrogen 0. 384 g /kg/ day. glucose 6. 3g/kg/day. lipid 2. 8g/kg/day, nonprotein kcal N= 131. 25 ) for 23 dogs of both groups was begun on the first day following operation and continued for the next 7 days. On postoperative 8th day. T1BC in group PN-pv was significantly higher than in group PN-cv. Blood glucose on first. 3rd and 7th days in group Pn-pv was significantly lower than in group Pn-cv. On 4th, 8th postoperative day, plasma levels of valine, isoleusine, leusine of two groups were significantly higher than those on preoperative. On 4th, 8th postoperative day palsma levels of valine, isoleusine, leusine in group Pn-pv were significantly higher than those in group Pn-cv. Urinary excretion of 3-methylhistidine on 3rd and 7th day in group Pn-pv were significantly lower than those in group Pn-cv. Hepatocytic cholestasis were found in six dogs of group Pn-cv and none of the dcgs of group Pn-pv showed this changes at histologic examination. Our conclusion is that short-term PN via portal vein is feasible and metabolically superior to PN via central vein and can avoid the cholesiasis.