肠道营养和静脉营养对严重烧伤所致肠道损害的影响

Effects of enteral nutrition and parenteral hyperalimentation on intestine damage induced by severe burns

目的 观察肠道营养和静脉营养对严重烧伤所致肠道损害的影响并探讨其机制。方法 采用 3 0 %体表面积Ⅲ度烧伤大鼠模型 ,80只大鼠随机分成静脉营养 (PN)及肠道营养 (EN)组 ,另取 8只大鼠作为伤前对照 (Control)。EN和PN组给予相同的营养液 ,剂量为每天 1 52ml/kg(73 2 .2kJ/kg) ,糖、脂肪及蛋白的供热比分别为 54 .5∶3 1 .5∶1 4,其中糖 1 53g/L ,卡氮比为 1 83∶1。检测肠粘液层厚度、肠粘膜增殖细胞核抗原 (PCNA)、血浆内毒素含量及血浆二胺氧化酶 (DAO)活性。结果 同PN组相比 ,EN组大鼠肠道受损程度、血浆内毒素水平及DAO活性明显降低 ,而肠粘膜PCNA值及肠粘液层厚度则明显高于PN组。结论 静脉营养可减轻肠粘膜受损程度 ,促进肠粘膜修复。

Objective To explore the mechanism and effects of enteral nutrition and parenteral hyperalimentation on intestine damage in severe burn injury. Methods A total of 80 Wistar rats with 30% TBSA fullthickness burn were randomly divided into two groups: namely burned and enteral nutrition (EN) and burned and parenteral nutrition (PN). Another 8 Wistar rats were used as normal control(Control). In EN and PN group, rats were supplied with 152 ml/kg (732.2 kJ/kg). Day of same nutritional solution, the supplied energy ratio of glucose, fat and protein was 54.5: 31.5: 14 respectively, among these glucose was 153 g/L and the proportion of calorie to nitrogen was 183∶1. Some vitamines and trace elements were added. Indices including the activity of diamine oxidase (DAO), the level of plasma endotoxin, intestinal proliferating cell nuclear antigen (PCNA) and thickness of mucus layer were determined. Results After burn injury, the structure of intestine was severely damaged and the activity of DAO as well as plasma endotoxin was significant increased. On the other hand, intestinal PCNA and thickness of mucus layer were decreased remarkably. In PN group, the intestinal injury, DAO activity and plasma endotoxin level were lighter than that in EN group while the intestinal PCNA thickness of mucus layer were increased in EN group. Conclusion Enteral nutrition is beneficial in minimizing intestine injury, promoting repairment of intestinal mucosa.