李峰，徐传博，夏红星，谢荣俊，王辉（南华大学附属南华医院　普外科，湖南　衡阳　421002）



不同时机早期肠内营养对重症急性胰腺炎大鼠肠黏膜屏障的影响

李峰，徐传博，夏红星，谢荣俊，王辉
（南华大学附属南华医院普外科，湖南衡阳421002）

[摘 要]目的 研究不同时机启动早期肠内营养（enteral nutrition，EN）对重症急性胰腺炎（severe acute pancreatitis，SAP）大鼠肠黏膜屏障功能和结构的影响。方法 将75只健康雄性大鼠随机分为空白组（S组，n=15）、实验组（EN组，又分为EN-1、EN-2和EN-3组，各n=15）和对照组（TPN组，n=15）。S组仅翻动内脏，余组建立SAP模型。造模后，S组正常喂食；TPN组采用肠外营养；EN-1、EN-2和EN-3组分别于建模后第1、2、4天启动EN。各组于建模后第2、3、5天分别处死5只大鼠，心脏采血检测淀粉酶（amylase，AMS）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白细胞介素-10（interleukin-10，IL-10）、血清内毒素（endotoxin，ET）的变化，取末端回肠作病理组织学检查并评分。结果 建模后第2天，空白组与EN组、对照组各指标差异有统计学意义（P＜0.01），EN组和对照组四组之间差异均无统计学意义（P均＞0.05）；建模后第3、5天，EN组各指标低于对照组，随着治疗持续，四组指标水平均呈下降趋势（P＜0.05），EN-1组下降最明显。结论 启动早期EN利于控制胰腺炎和保护肠道黏膜屏障，越早启动越有利。

[关键词]重症急性胰腺炎；肠内营养；肠黏膜屏障；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

重症急性胰腺炎（severe acute pancreatitis，SAP）是常见临床危重急症，发病机制复杂，病死率高，可达30%以上[1]。SAP病程早期可发生肠道黏膜屏障损伤，导致肠道细菌和内毒素移位，继发胰腺坏死组织及胰周积液感染，产生内毒素血症，随即介导发生全身炎症反应综合征（systemic-inflammatory response syndrome，SIRS），最后可致多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS），危及患者生命[2-3]。……