营养支持途径对严重烧伤早期肠黏膜修复的影响

Effects of nutrition route on repair of intestinal mucosa in severe burns

目的:探讨营养支持途径对严重烧伤早期肠黏膜修复的影响.方法:将30%TBSAⅢ度烧伤大鼠行颈外静脉插管后,随机分为肠道喂养(EF)组及静脉营养(PN)组,分别采用灌喂和颈外静脉输入方法给予等氮、等热卡的营养液.动态观察空肠与回肠黏膜组织形态学的变化,用图像分析仪测量肠黏膜厚度、绒毛高度,并计算绒毛表面积.结果:烧伤后早期PN组与EF组的空肠与回肠黏膜组织结构均受到明显损害.EF组伤后6,12,24,48h空肠和回肠黏膜厚度分别为341±33μm、404±30μm、418±42μm、418±57μm及313±34μm、306±81μm、302±55μm、268±21μm,绒毛高度分别为253±33μm、287±23μm、285±42μm、260±40μm及175±30μm、210±57μm、190±31μm、163±17μm,绒毛表面积分别为0.045±0.011mm2、0.056±0.011mm2、0.071±0.007mm2、0.054±0.006mm2及0.030±0.006mm2、0.045±0.019mm2、0.036±0.011mm2、0.028±0.004mm2,均与PN组无明显差别(P>0.05).但至伤后72h,EF组空肠和回肠黏膜厚度、绒毛高度及绒毛表面积分别为397±34μm、253±41μm、0.051±0.009mm2及275±38μm、180±31μm、0.030±0.006mm2,而PN组空肠和回肠黏膜厚度、绒毛高度及绒毛表面积分别为227±25μm、146±14μm、0.024±0.0062mm2及206±15μm、125±16μm、0.017±0.0042mm2,EF组非常明显地高于PN组(P<0.01).结论:肠道喂养较静脉营养能更好地维护严重烧伤后早期肠黏膜组织结构,促进受损肠黏膜的修复.

AIM:To investigate the effects of nutrition route on repairof intestinal mucosa in the early stage of severe burns.METHODS:Rats inflicted with 30 %TBSA Ⅲ dgree burnswere randomly divided into enteric feeding (EF) group andintravenous parenteral nutrition (PN) group. To each animal ofboth groups, equal volume of nutritional support fluid containingpredetermined amount of calories and nitrogen was sup-plied at 2 hr postburn (PBH). At 0, 6, 12, 24, 48, 72 PBH,mucosa thickness, villus height, and villus surface area inboth jejunum and ileum were measured respectively.RESULTS:Morphologically, jejunal and ileal mucosa wereseverely damaged in both groups after burn injury. At 6,12, 24 and 48 PBH, jejunal and ileal mucosa thickness in EFgroup were 341 ± 33 μm, 404 ± 30 μm, 418 ± 42 μm,418± 57 μm, and 313 ± 34 μm, 306 ± 81 μm, 302 ± 55 μmand 268 ± 21 μm respectively; and jejunal and ileal villusheight were 253 ± 33 μm, 287 ± 23 μm, 285 ± 42 μm,260± 40 μm, and 175 ± 30 μm, 210 ± 57 μm, 190 ± 31 μmand 163 ± 17 μm respectively; and jejunal and ileal villussurface area were 0.045±0.011 mm2, 0.056±0.011 mm2,0.071±0.007 mm2, 0.054±0.006 mm2, and 0.030±0.006 mm2,0.045±0.019 mm2, 0.036±0.011 mm2 and 0.028±0.004 mm2respectively, which were similar to those in PN group (P >0.05).But at 72 PBH, jejunal and ileal mucosa height, villus heightand villus surface area in EF group were 397 ± 34 μm,253 ± 41 μm, 0.051 ± 0.009 mm2, and 275 ± 38 μm,180±31 μm, 0.030±0.006 mm2 respectively,which weresignificantly higher than those in PN group (227 ± 25 μm,146 ± 14 μm, 0.024 ± 0.0062 mm2, and 206 ± 15 μm, 125±16 μm and 0.017±0.0042 mm2 respectively) (P <0.01).CONCLUSION:Early enteric feeding is superior to parenteralnutrition in maintaining intestinal mucosa structure, andaccelerating repair of the damaged intestinal mucosa insevere burn injury.