急性坏死性胰腺炎大鼠早期肠内营养的实验研究

Experimental study of early enteral nutrition on acute necrotizing pancreatitis in rats

目的 :探讨经空肠肠内营养 (EN)在急性坏死性胰腺炎 (ANP)早期使用的可行性 ,及其对胰腺炎时肠道细菌移位的影响。方法 :6 8只成年 SD大鼠 ,随机分为正常对照组 (A) 12只、实验对照组 (B) 2 7只和治疗组(C) 2 9只 ,均剖腹行胰胆管逆行穿刺和空肠造瘘。 A组经胰胆管注入生理盐水 (NS) 0 .2 ml/10 0 g,B、C组注入质量分数为 3.5 %的牛磺胆酸 0 .2 m l/10 0 g制成 ANP模型。 C组于模型建立 1小时内经空肠造瘘管注入爱伦多 (Elental) ,3次 /2 4 h,每次 10 ml(4184 k J/L )。结果 :胰腺病理检查示 :A组 12只大鼠 (10 0 .0 0 % )胰腺组织基本正常 ;B组 2 7只 (10 0 .0 0 % )和 C组 2 1只 (72 .4 1% )胰腺组织呈片、灶状坏死、出血 ,大量炎性细胞浸润 ,C组中另 8只大鼠 (2 7.5 9% )胰腺间质水肿 ,少量炎性细胞浸润。C组大鼠 2 4小时存活率比 B组提高 ,差异有显著性 (P<0 .0 1)。B、C2组间血清钙及淀粉酶水平无差异 (P均 >0 .0 5 )。 3组大鼠血清内毒素 :B、C2组较 A组明显升高 ,C组较 B组明显下降 (P<0 .0 1或 P<0 .0 5 )。 3组大鼠肺、肾、肝、脾及 ML N细菌培养计数 (cfu/g) :B、C 2组均较 A组高 ,C组低于 B组 ,差异有高度显著性 (P均 <0 .0 1)。结论 :ANP大鼠早期经空肠给予肠内营养安全、可靠 ,未加重胰腺?

Objective:To investigate the feasibility of early enteral nutrition(EEN) on acute necrotizing pancreatitis(ANP),and the influence of EEN on ameliorating the bacterial and endotoxic translocations from intestine tract.Methods:Sixtyeight SD rats were randomly divided into 3 groups:sham operation group(group A, n =12),experiment control group(group B, n =27) and treatment group(group C, n=29 ).Right internal jugular vine indwelling catheter was inserted for normal saline transfusion,2 ml/h.Pancreasbile duct retrogrand puncture and jejunum fistula were made in all rats.While pancreasbile duct retrogrand puncture was accomplished,normal saline 0 2 ml/100 g were injected for group A,and 3 5% taurocholic acid 0 2 ml/100 g were injected for group B and C.In group C Elental(10 ml,4 184 kJ/L) was given by jejunum fistula 1 hour after the set up of ANP model,3 times per 24 hours.Results:The pathology examination after 24 hours showed that the pancreas tissue were normal in all rats of group A(12/12,100 00%);dot and(or) patch necrosis,hemorrhage,a great deal of inflammatory cell soakage in all rats of group B(27/27,100 00%) and in 21 rats of group C( 21/29, 72 41%);and a interstitial edema,a little of inflammatory cell soakage in another 8 rats of group C( 8/29, 27 59%).Survival rate of 24 hours was evidently improved in group C than in group B( P <0 01).The serum endotoxin levels were obviously higher in group B and group C than in group A(both P <0 01),while that of group C was markedly declined than group B( P <0 05).The lung,kidney,liver,spleen and mesentery lymph nodes(MLN) tissue germiculture counts(colony forming units,cfu/g) were significantly different in 3 groups,and obviously increased in group B and group C than in group A,whereas the tissue germiculture counts in group C was markedly reduced than in group B,there was significantly difference between 2 groups(all P <0 01).Conclusions:EEN by jejunum fistula is safer in ANP cases,it does not aggravate the state of ANP.The survival rate of 24 hours increases obviously,and the bacterial and endotoxic translocations from intestine tract are alleviated.