严重烧伤后营养支持途径对机体肠道功能的影响

Effects of different routes of nutritional support on intestinal functions in early stage of severe burns

目的 :考察严重烧伤早期两种营养支持途径对机体肠道功能的影响。方法 :19例烧伤病人随机分为早期肠道营养组 (EN )和肠外营养组 (PN) ,分别于伤后 1、4、8、14d测胃泌素、胃动素、MDA、SOD、内毒素、TNF、DAO及肠道通透性。结果 :EN组血胃泌素、胃动素PBD4、PBD8显著高于PN组 (P <0 0 5 ,P <0 0 1) ,血浆MDA在PBD4、PBD8显著低于PN组 (P <0 0 1) ,EN组SOD在PBD4、PBD8显著低于PN组 (P<0 0 1)。EN组血清DAO呈下降趋势 ,PBD4显著低于PN组 (P <0 0 1) ,内毒素和TNF在PBD1后大多数时相点EN组均显著低于PN (P <0 0 1)。L/M比值PBD4、PBD8EN组显著低于PN组。L/M与DAO、MDA、TNF呈显著正相关 (P <0 0 1) ,与SOD呈显著负相关 (P <0 0 1)。结论 :早期肠道营养促进肠道分泌和运动功能 ,减轻肠道缺血再灌注损伤 ,降低肠道通透性 ,减少内毒素入血和炎症介质的释放 ,较好地维护了肠粘膜屏障功能。在本组病例 ,早期肠道营养优于静脉营养。

Objective: To study the clinical effects of enteral and parenteral nutrition on the intestinal functions in the early stage of severe burn injury Methods: 19 cases of severe burns were divided into enteral (EN) and parenteral (PN) nutrition groups Gastrin, motilin, MDA, SOD, endotoxin, TNF, DAO and L/M ratio were determined on the 1st, 4th, 8th and 14th day postburn Results: On the 4th and 8th day postburn, serum gastrin and motilin were significantly higher in EN group than in PN group (P< 0 05～0 01), plasma MDA was obviously lower in EN group than in PN group (P< 0 01), and plasma SOD was markedly higher in EN group than in PN group (P< 0 01) Endotoxin and TNF were significantly lower in EN group than in PN group at most time points (P< 0 01) Serum DAO tended to decrease in EN group at most time points and it was obviously lower in EN group than in PN group on the 4th day (P< 0 01) L/M ratio was obviously lower in EN group than in PN group on the 4th and 8th day (P< 0 05～0 01) and it was correlated positively with DAO,MDA and TNF (P< 0 05～0 01) and negatively with SOD (P< 0 01) Conclusion: Our findings indicate that enteral nutrition is superior to parenteral nutrition in the early stage of severe burn injury Enteral nutrition can effectively pereserve secretory function and motility of the gastrointestinal tract, minimize ischemia reperfusion injury of the intestines, reduce the intestinal permeability and decrease the level of plasma endotoxin and mediators of inflammation and maintain the barrier function of the intestinal mucosa