摘要
我们以部分空肠段旷置——胃造口——烧伤(25%)家兔模型就烧伤早期肠道营养对肠粘膜的保护及其可能机制进行了探讨。39只家兔(2.0±0.5kg)随机分为三组即:正常对照组(不烧伤并自由进食)早期喂养组与烧伤对照组(致伤后30分钟内按75ml/kg·24小时经饲管分别持续泵入营养液和冷开水)。结果显示:烧伤对照组肠粘膜氧耗量、肠组织尿酸及丙二醛显著增加,肠粘膜下血流量显著减少。早期喂养组粘膜氧耗量接近正常,血流量高于烧伤及正常对照组,尿酸及回肠段丙二醛显著低于烧伤对照组。空肠旷置段与非旷置段的粘膜氧耗量及肠组织次黄嘌呤、黄嘌呤、丙二醛均无显著差异。所以,烧伤早期肠道营养对肠粘膜有保护作用,可降低肠粘膜氧耗量,改善粘膜下血流量,减轻再灌注损伤。喂养的食物除对粘膜的局部作用,可能还涉及由“食物作用”介导的整体性调节因素。
The mechanisms of the protection of gut mucosa with early enteral feeding in burns were investigated.A 25% TBSA burn rabbit model,in which a gastrostomy,and a blind segment of the jejunum were formed before the thermal injury.39 rabbits were ran- domly divided into three groups:A.burn and feeding with the nutritional fluid within 30 minutes postburn through gastrostomy.B.same as A except feeding with cold water instead of nutritional fluid;and C.no burn and fed freely.The results showed that burn injury caused an increase in mucosal oxygen comsumption,intestinal uric acid formation and MDA (malondialdehyde) production,and dcerease in submucosal blood flow.However,these were significantly improved by early enteral feeding after burn injury.The changes in the mucosa of the jejunal blind segment were similar to that of the rest of jejunum.It indicated that the effect of enteral feeding might be a systemic as well as a local one.It is concluded that the early enteral feeding can maintain the mucosal function and structure of the gut,as evidenced by a decrease in the mucosal hypermetabolism,improvement in submucosal blood flow and reduction in gut injuries as a result of reperfusion.
基金
国家自家科学基金资助
关键词
烧伤
早期肠道营养
肠粘膜保护
Early enteral feeding
Maintaining of gut mucosa
Burn
