不同時機早期腸內營養對重癥急性胰腺炎大鼠腸黏膜屏障的影響

李峰，徐傳博，夏紅星，謝榮俊，王輝（南華大學附屬南華醫院　普外科，湖南　衡陽　421002）

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不同時機早期腸內營養對重癥急性胰腺炎大鼠腸黏膜屏障的影響

李峰，徐傳博，夏紅星，謝榮俊，王輝
（南華大學附屬南華醫院普外科，湖南衡陽421002）

[摘 要]目的 研究不同時機啟動早期腸內營養（enteral nutrition，EN）對重癥急性胰腺炎（severe acute pancreatitis，SAP）大鼠腸黏膜屏障功能和結構的影響。方法 將75只健康雄性大鼠隨機分為空白組（S組，n=15）、實驗組（EN組，又分為EN-1、EN-2和EN-3組，各n=15）和對照組（TPN組，n=15）。S組僅翻動內臟，余組建立SAP模型。造模后，S組正常喂食；TPN組采用腸外營養；EN-1、EN-2和EN-3組分別于建模后第1、2、4天啟動EN。各組于建模后第2、3、5天分別處死5只大鼠，心臟采血檢測淀粉酶（amylase，AMS）、腫瘤壞死因子-α（tumor necrosis factor-α，TNF-α）、白細胞介素-10（interleukin-10，IL-10）、血清內毒素（endotoxin，ET）的變化，取末端回腸作病理組織學檢查并評分。結果 建模后第2天，空白組與EN組、對照組各指標差異有統計學意義（P＜0.01），EN組和對照組四組之間差異均無統計學意義（P均＞0.05）；建模后第3、5天，EN組各指標低于對照組，隨著治療持續，四組指標水平均呈下降趨勢（P＜0.05），EN-1組下降最明顯。結論 啟動早期EN利于控制胰腺炎和保護腸道黏膜屏障，越早啟動越有利。

[關鍵詞]重癥急性胰腺炎；腸內營養；腸黏膜屏障；大鼠

Effect of early enteral nutrition at different periods on intestinal mucosa barrier in rats with severe acute pancreatitis

LI Feng,XU Chuan-bo,XIA Hong-xing,XIE Rong-jun,WANG Hui.Department of General Surgery,Nanhua Hospital Affiliated to University of South China,Hengyang,Hunan 421002,China

Abstract objectiveTo investigate the effect of early enteral nutrition(EN)at different period on intestinal mucosa barrier and pathology in rats with severe acute pancreatitis(SAP).MethodsA total of 75 male rats were randomly allocated into following groups:blank group(S group,n=15),experimental group(EN group,45 rats were then randomly divided into EN-1,EN-2 and EN-3 sub group,each n=15)and control group(TPN group,n=15).Rats in S group only had their viscera turned,while rats in other two groups were used to establish severe acute pancreatitis model.After successful modeling,the S group received normal diet,the TPN group received support and treatment by total parenteral nutrition.EN-1,EN-2 and EN-3 subgroup respectively started enteral nutrition at day 1,day 2 and day 4 after modeling.At the day 2,day 3 and day 5 after modeling,5 rats in each group were sacrificed.Then the heart blood sampling were taken to detect serum levels of amylase(AMS),tumor necrosis factor-α(TNF-a),interleukin-10(IL-10)and endotoxin(ET),and the terminal ileum tissue was taken for histopathologic examination and evaluation.ResultsAt day 2,compared with EN subgroups and TPN group,indexes in S group were significantly different(P＜0.01),and there was no significant difference between EN groups and TPN group(P＞0.05).At day 3 and day 5,indexes in EN group were lower than those in TPN group,and these four groups showed a downward trend along with the treatment(P＜0.05).The EN-1 group decreased most significantly.ConclusionStarting early enteral nutrition can control the progress of SAP in rats,and protect intestinal mucosal barrier,the sooner the better.

Key words severe acute pancreatitis; enteral nutrition; intestinal mucosa barrier; rats

重癥急性胰腺炎（severe acute pancreatitis，SAP）是常見臨床危重急癥，發病機制復雜，病死率高，可達30%以上[1]。SAP病程早期可發生腸道黏膜屏障損傷，導致腸道細菌和內毒素移位，繼發胰腺壞死組織及胰周積液感染，產生內毒素血癥，隨即介導發生全身炎癥反應綜合征（systemic-inflammatory response syndrome，SIRS），最后可致多器官功能障礙綜合征（multiple organ dysfunction syndrome，MODS），危及患者生命[2-3]。……