早期肠内营养对犬重症急性胰腺炎自然病程和肠道屏障功能的影响

Effect of Early Enteral Nutrition on the Natural Course in Dogs with Severe Acute Pancreatitis

目的 观察早期肠内营养对犬重症急性胰腺炎 (SAP)自然病程和肠道屏障功能的影响。方法 在SAP动物模型基础上将 15只犬随机分为肠外营养组 (PN组 )和早期肠内营养组 (EEN组 )。EEN组在术后 2 4h实施经空肠营养 ,共 7d。两组的供热、氮及液体量基本相等。两组动物分别于SAP模型制作前及制作后 3 0min及营养支持后 1d、4d及 7d测定外周血血糖、血钙、淀粉酶、溶酶体酶及内毒素含量 ;第 7d实验结束前 4h ,经静脉注入12 5I 白蛋白以测定胰腺通透性 ;实验结束后处死动物取门静脉血、肺组织、胰腺组织及肺门淋巴结和肠系膜淋巴结检测其中的细菌量 ,同时观察胰腺组织的病理学改变 ,结果作病理评分。测定小肠和结肠蛋白质和DNA含量以及粘膜形态学变化。结果 SAP动物模型制成后 ,血糖浓度升高 ,EEN组血糖浓度较PN组易于控制 ;两组动物的血钙、血淀粉酶和溶酶体酶水平在模型制作前后变化差异无显著性意义 ;胰腺 /血液及胰腺 /肌肉的12 5I 白蛋白标记指数比值两组间差异无显著性意义 ;EEN组外周血内毒素含量及门静脉血、胰腺及远隔脏器细菌数均明显低于PN组 (P<0 .0 5 )。胰腺病理评分两组间差异无显著性意义。EEN组肠壁蛋白质和DNA含量明显高于PN组 (P<0 .0 5 )。在绒毛高度。

Objective To evaluate the effect of the early enteral nutrition(EEN) on the natural course in dogs with severe acute pancreatitis(SAP).[WT5”HZ]Methods [WT5”BZ]SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8 000-10 000 BAEE units trypsin/ml into pancrease via pancreatic duct.Fifteen dogs were divided into parenteral nutrition(PN) group and EEN group.Two groups were isonitrogenous and isocaloric.EEN was used at postoperative 24 h.Systemic plasma endotoxin level was quantified by the chromogenic limulus amebocyte lysate technique.Both portal and systemic blood sample were obtained before and 1,4,7 d following SAP, and cultured for aerobic as well as anaerobic bacterial.Serum glucose, calcium,amylase and lysosomal enzymes were determined.All dogs were injected with 1.85×106 Bq 125I-BSA 4 h before sacrificed.The 125I-BSA index of the pancreas/muscle and pancreas/blood was measured,and pancreas pathology was observed.Specimens of tissue from mesenteriolum and mesocolon lymph nodes,lung,pulmonary portal lymph nodes and pancreas were removed,weighed and homogenized in grinding tubes.Aliquots of the homogenata were cultured as blood mentioned above.The thickness of mucosa,the whole gut layer,the height of intestinal villi and their protein and DNA contents in the intestinal and transverse colon were determined.[WT5”HZ]Results [WT5”BZ]The study showed that EEN significantly reduced the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ,serum glucose in PN group was higher than that in EEN after SAP 4 d.There were no difference between two groups in the data of serum calcium,amylase and lysosomal enzymes,pathologic index and 125I-BSA index of pancreas/muscle and pancreas/blood.EEN improved the gut barrier function by increasing the thickness of mucosa,the whole gut layer and the height of intestinal villi,increasing its protein and DNA contents in the bowel.[WT5”HZ]Conclusion [WT5”BZ]Our results suggest that EEN is safe and effective,and can decrease the rate of intestinal bacterial translocation. [WT5”HZ]