摘要
目的研究肠道低灌注状态下实施早期肠内营养(EEN)时小肠功能指标及耐受能力的变化。方法健康雄性杂种犬24只,夹闭肠系膜上动脉(SM A)1 h后恢复灌注造成肠缺血/再灌注(I/R)损伤,复流后4 h实施EEN,将瑞代营养液(4 m l.k-g 1.-h 1)经肠黏膜张力计管持续滴注3 h,如果动物出现肠道不能耐受症状(如呕吐、腹泻等)则停止,间隔6 h后再次实施EEN,直至动物肠道能够耐受为止。按随机数字表法将动物分成单纯EEN组、单纯I/R组、I/R后EEN组(I/R+EEN组),每组8只。检测小肠黏膜二氧化碳分压(P iCO2)、D木糖吸收量、小肠腔内压力判定小肠灌注和功能变化。结果肠I/R+EEN组肠道不能耐受发生率(87.5%)和严重程度均显著高于单纯EEN组(0)和单纯I/R组(12.5%)。实施EEN后,与单纯I/R组和单纯EEN组相比,I/R+EEN组小肠腔内压力及肠P iCO2均显著升高,而血浆D木糖吸收量显著降低(P均<0.01)。结论肠I/R能显著降低小肠对EEN的耐受能力,肠I/R后过早(<12 h)实施EEN能加重小肠I/R损伤,并进一步抑制小肠吸收和运动功能。
Objective To investigate the effects of early enteral nutrition （EEN） on intestinal function and gut tolerance after intestinal ischemia/reperfusion （I/R） injury. Methods Twenty-four male dogs were randomly divided into three groups： EEN only, I/R only and I/R ＋EEN. The superior mesenteric artery （SMA） was blocked for 1 hour followed by restoration of blood flow. EEN was given 4 hours after reperfusion by continuous infusion of Fresubin nutrition fluid （4 ml·kg^-1·h^-1, Fresenius Kabi Co, Germany） into gut via a tonometric catheter for 3 hours till intolerance symptoms, which including vomiting and diarrhea which indicated gut intolerance. CO2 partial pressure of intestinal mucosa （PiCO2）, D -xylose absorption and intestinal luminal pressure were measured to reflect intestinal function and perfusion. Results Incidence and severity of diarrhea and vomiting were significantly higher in I/R ＋ EEN group （with 87.5 intolerance） than those in I/R only group （12.5%） and EEN only group （0）. After EEN, PiCO2 and intestinal cavity pressure were significantly higher, and the D- xylose absorption much lower, in the I/R＋EEN group compared with the I/R group and EEN group （all P〈0. 01）. Conclusion Intestinal I/R may result in decreased tolerance to EEN. Too early enteral nutrition （less than 12 hours after gut hypoperfusion） may enhance intestinal ischemia injury and further inhibit its function of propulsion and absorption.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2006年第10期605-608,共4页
Chinese Critical Care Medicine
基金
北京市科技计划重大项目课题(2002641)
关键词
肠内营养
缺血/再灌注损伤
肠
动物模型
肠耐受
enteral nutrition
gut ischemia/reperfusion injury
animal model
gut tolerance
