早期肠内营养及其方式对重症急性胰腺炎的影响

Effects of Early Enteral Nutrition under Different Modes on Severe Acute Pancreatitis

目的观察早期肠内营养及其不同方式对重症急性胰腺炎的影响。方法采用胰管逆行注射法建立大鼠重症急性胰腺炎模型,假手术组用生理盐水替代牛磺胆酸钠,所有大鼠均经胃造瘘口空肠置管,SAP组随机分为持续、间隙和未进行肠内营养三个亚组(每组12只),假手术组同样分为三个亚组(每组8只),48h后启动肠内营养;72h后再次麻醉大鼠,收集组织及血液标本;检测指标包括:肠道转运系数、血淀粉酶、器官细菌移位率、血清细胞因子(TNF-α和IL-1β)、胰腺病理评分、血浆D-乳酸等。结果(1)SAP后48h进行肠内营养并未加重胰腺炎,行肠内营养组与未行肠内营养组,在血淀粉酶、胰腺病理评分方面,差异无统计学意义(P>0.05);然而早期肠内营养可以促进肠蠕动,减少肠道细菌移位率,二组间在肠道转运系数、脏器细菌移位率及血清TNF-α水平方面,差异有统计学意义(P<0.05)。(2)重症急性胰腺炎肠内营养的二种方式,各项指标之间的比较无显著差异。结论SAP大鼠在早期经空肠行肠内营养是可行的,保持了肠道完整性、减少了脏器细菌移位率,但未改善预后;对SAP大鼠来说,持续和间隙二种肠内营养输注方式间差异无显著意义,二者相当。

Objectives To observe the effects of enteral nutrition under different modes on the severe acute pancreatitis.Methods Severe acute pancreatitis was induced in the wistar rats by retrograde pressure injection of3.5%sodium taurocholate into the biliopancreatic duct,saline was used instead of sodium taurocholate in the sham groups,and catheters were placed into the jejunum via a gastrostomy in all rats.The rats with SAP were randomly divided into three groups according to different feeding modes,continuous and intermittent enteral nutrition or without enteral nutrition(each n=12).The rats in the sham group were also grouped into three sub-groups according to different feeding modes(each n=8).Enteral nutrition were initiated after48hours and the rats were sacrificed in72hours,the tissues and the blood samples were collected for further study.Main outcome measures were:intestinal transmit index,bacterial translocation rate(culture of mesenteric lymph node,liver and spleen),serum amylase,serum cytokines as TNF-αand IL-1β,histological score of the pancrea,and the plasma level of D-lactate.Results(1)There was no significant difference in serum amylase and histological scores between the SAP/A-B(with EN)and SAP/C(without EN)48hours after the induction of SAP,P>0.05.However,early enteral nutrition might be benefitial to the intestinal motility and reduced the bacterial translocation rate,there were significant differences in intestinal transmit index,organ bacterial translocation rate,and serum TNF-αlevel (P<0.05).(2)There was no significant difference between the two enteral nutrition modes in the six outcome measures.Conclusions Jejunal administration of EN was well tolerated in early SAP,which maintained gut integrity and reduced bacterial translocation,but did not improve outcome.Continuous or intermittent feeding modes are associated with similar outcome in SAP.