通腑颗粒改善犬缺血-再灌注时小肠对早期肠内营养的耐受能力  

The effects of Tongfu pellets (通腑颗粒) on gut tolerance to early enteral nutrition following intestinal ischemia and reperfusion in dogs

作　　者：胡森[1] 夏斌[2] 黎君友[1] 陈廷秀[1] 段美丽[3] 张淑文[3] 

机构地区：[1]解放军总医院第一附属医院烧伤研究所休克与多器官功能障碍实验室,北京100037 [2]解放军251医院,张家口121001 [3]首都医科大学附属北京友谊医院,北京100050

出　　处：《感染．炎症．修复》2006年第4期197-200,共4页Infection Inflammation Repair

基　　金：军队"十五"课题(01L081);北京市科技计划重大项目课题(2002-641)

摘　　要：目的:研究通腑颗粒对肠缺血-再灌注(I／R)状态下实施早期肠内营养(EEN)时小肠耐受能力的影响。方法:健康雄性杂种犬32只,夹闭肠系膜上动脉1h后恢复灌流造成肠I／R损伤,复流后4h实施EEN,将瑞代营养液(4 ml·kg^(-1)·h^(-1))经肠黏膜张力计管持续滴注3h直至动物出现肠道不能耐受症状时停止,间隔6h后再次实施EEN,直至动物肠道能够耐受为止。动物随机分成单纯EEN组(EEN级)、单纯缺血-再灌注组(I／R组)、缺血-再灌注后EEN组(I／R+EEN组),I／R+EEN+通腑颗粒组(I／R+EEN+TF组),每组8只。检测小肠黏膜PCO_2(PiCO_2)、血浆二胺氧化酶(DAO)活性以及病理形态学改变。结果:肠I／R后各组PiCO_2和血浆DAO均较单纯EEN组显著升高,并有明显的肠黏膜病理损害。肠I／R+EEN组上述病变最重,肠道不能耐受发生率(87．5％)显著高于EEN组(O)和I／R组(12．5％)。通腑颗粒治疗组小肠功能指标的变化显著轻于I／R+EEN组,表现为肠PiCO_2和血浆DAO活性明显降低,肠组织病理损害减轻。结论:通腑颗粒能显著改善肠组织灌流及功能指标,减轻肠黏膜的病理损害,提高犬I／R时小肠对早期肠内营养的耐受能力。Objective:To investigate the effects of Tongfu pellets (通腑颗粒) on gut tolerance to early enteral nutrition (EEN) after intestinal ischemia and reperfusion (I/R).Methods:Thirty-two male dogs were used in the study.The superior mesenteric artery (SMA) was blocked for 1 hour and then SMA blood flow was restored. EEN was given 4 hours after reperfusion by continues gavage of Fresubin nutrition fluid (4 ml·kg^(-1)·h^(-1)) into gut via a tonometric catheter for 3 hours till intolerance symptoms occurred.Tongfu pellets consisting of Chinese medicinal herbs were given enterally in a dose of 0.3 g/kg 5 minutes after EEN.Animals were randomly divided into four groups:EEN only,I/R only,I/R+EEN and I/R+EEN+Tongfu pellets (I/R+EEN+TF).Gut intol- erance was assessed by monitoring the symptoms of diarrhea and vomiting.The intestinal mucosal PCO_2(PiCO_2), liamine oxidase (DAO) activity and histopathological changes were determined.Results:I/R resulted in significant increase in the DAO activity and PiCO_2 level in I/R and I/R+EEN group compared with those in EEN group,and there were also sever mucosal pathologic changes in the latter.Significant lowering of plasma DAO activity and mucosal PiCO_2,and milder pathological injury were found in I/R+TF compared with those in I/R and I/R+EEN group.Conclusion:Intestinal I/R may result in gut intolerance to EEN.Tongfu pellets exerts an effect of im- provement on gut tolerance to EEN by attenuating functional and pathological changes in gut following I/R injury.

关 键 词：颗粒组 肠缺血 再灌注 小肠黏膜 早期肠内营养 耐受能力 ischemia and reperfusion 病理损害 功能指标 血浆 动物肠道 肠组织 肠系膜上动脉 形态学改变 二胺氧化酶 组织灌流 活性 持续滴注 治疗组 张力计 

分 类 号：R[医药卫生]