失血性休克后早期肠道喂养效果的实验研究

The effects of early enteral feeding on rats after hermorrhagic shock

目的 :研究大鼠失血性休克后早期肠道喂养对胃肠结构与功能、应激与代谢相关的激素、全身营养状况的影响。 方法 :随机将 72只大鼠分为假休克组 (SS组 )、休克组 (HS组 )、早期肠道喂养组 (HSE组 )。SS组自由进食 ,HSE组复苏后 1h用安素营养液喂养 ,HS组用等量等渗盐水喂养。选择复苏后 2、6、2 4、48h四个时相点观察体重 ,肝总重及腓肠肌重 ,血浆总蛋白及白蛋白浓度 ,肝及腓肠肌含氮量 ,胃及空肠粘膜丙二醛含量 ,Na+ K+ATP酶活性 ,肝功能 ,血浆皮质醇、胰高血糖素、胰岛素水平 ,肝、小肠、胃组织形态学变化。 结果 :与HS组相比 ,HSE组体重、血浆总蛋白及白蛋白、肝及腓肠肌含氮量等营养指标明显改善 ,肝功能改善 ,血浆皮质醇、胰高血糖素水平降低 ,胰岛素水平增高 ,胃肠粘膜病变减轻。 结论 :HS后早期肠道喂养有助于保护内脏功能 ,降低应激与高代谢反应 。

Objectives:To investigate the effects of early enteral feeding(EEF) after hemorrhagic shock(HS) on gut structure and function,hormones for stress and metabolism and nutritional conditions. Methods:Seventy two Wistar rats were randomly divided into sham shock group(SS),HS group(HS) and post HS EEF gorup(HSE).HSE group was fed with ENSURE and HS group was fed with normal saline.EEF was started within 1 hour after resuscitation.The body weight,liver weight,musculus gastrocnemius weight,nitrogen content in liver and musculus gastrocnemius,total plasma protein level,albumin level,MDA(malondialdehyde) and Na + K + ATPase activity in stomach and jejunum mucosa, the change of liver function, the levels of glucagon,cortisol and insulin,and the pathological changes in stomach, small intestine and liver were investigated at 2,6,24,48 h after resuscitation. Results:When compared with HS group,the weight of body,liver and musculus gastrocnemius,the nitrogen content in liver and musculus gastrocnemius,the levels of total plasma protein and albumin and the liver function were significantly better in the HSE group.MDA content was less and Na + K + ATPase activity was higher in HSE group than those in HS group.The glucagon and cortisol levels were significantly lower and the insulin level was significantly higher in HSE group than those in HS group.The pathological changes in the stomach,intestine and liver in HSE group got an obvious improvement. Conclusions:After HS,EEF is helpful to maintain visceral organ function,reduce the stress and hypermetabolic response and improve the nutritional conditions.