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目的探讨肠内、肠外营养对急性胰腺炎大鼠肠黏膜、肝功能、炎性因子的影响。方法 60只Sprague-Dawley(SD)健康雄性大鼠,随机分为假手术组(sham operation group,S组,n=20),完全肠外营养组(total parenteral nutrition group,TPN,n=20),肠内营养组(enteral nutrition group,EN,n=20)。采用胰腺被膜下多点、缓慢、均匀注射3.8%牛黄胆酸钠,建立急性重症胰腺炎(severe acute pancreatitis,SAP)模型,分别在造模后第3、5、7、10、12天的5个时间点心脏穿刺取血,部分送检谷丙转氨酶(glutamic-pyruvic transaminase,ALT)、谷草转氨酶(glutamic oxalacetic transaminase,AST)、内毒素,其余样本及尿液离心后保存于-80℃,以备肿瘤坏死因子(tumor necrosis factor,TNF),IL-6,乳果糖(L)和甘露醇(M)比值检测,同时取胰腺、肝脏、回肠置于4%中性甲醛溶液中固定,后脱水、包埋、切片、HE染色,于光镜下观察胰腺、肝脏组织病理改变及回肠黏膜形态学变化。结果 EN组、TPN组SD大鼠营养支持耐受性良好,S组大鼠各项检查指标正常,EN组、TPN组各时间点水平明显改变,较S组差异明显(P<0.05)。SAP模型建成后EN组、TPN组各项检查指标升高,TPN组升高明显。内毒素、AST(5天,P<0.05),IL-6、TNF、L/M、ALT(7天,P<0.05),差异具有显著性。肝脏、胰腺、肠黏膜形态变化明显。结论肠内营养可以改善肠黏膜的通透性,防止菌群移位,减少二次感染发生,降低内毒素血症和炎性因子水平,保护肝功能。
Objective To investigate the effects of enteral and parenteral nutrition on intestinal mucosa, liver function and inflammatory factors in rats with acute pancreatitis. Methods Sixty Sprague-Dawley (SD) healthy male rats were randomly divided into sham operation group (n = 20), total parenteral nutrition group (n = 20) , Enteral nutrition group (EN, n = 20). Acute severe severe pancreatitis (SAP) model was established by multi-point, slow and uniform injection of 3.8% sodium taurocholate under the pancreas of the pancreas. The rats were sacrificed on the 3rd, 5th, 7th, At time point, blood was taken from the puncture of the heart, and some of them were subjected to glutamic-pyruvic transaminase (ALT), glutamic oxalacetic transaminase (AST) and endotoxin. The remaining samples and urine were centrifuged and stored at -80 ° C Tumor necrosis factor (TNF), interleukin-6 (IL-6), lactulose (L) and mannitol (M) were measured. Pancreas, liver and ileum were fixed in 4% , Embedded, sectioned and stained with hematoxylin-eosin (HE). The pathological changes of the pancreas and liver and the morphological changes of the ileal mucosa were observed under light microscope. Results The nutritional support of SD rats in EN group and TPN group was well tolerated. All indexes in S group were normal. The levels in EN group and TPN group were significantly changed at each time point, which were significantly different from those in S group (P <0.05). After the SAP model was established, the indexes of EN group and TPN group increased, and the TPN group increased significantly. The levels of endotoxin, AST (5 days, P <0.05), IL-6, TNF, L / M and ALT (7 days, P <0.05) were significantly different. Liver, pancreas, intestinal mucosa obvious changes in morphology. Conclusion Enteral nutrition can improve intestinal mucosal permeability, prevent bacterial translocation, reduce secondary infection, reduce endotoxemia and inflammatory cytokines, and protect liver function.