持续性早期肠内营养对急性坏死型胰腺炎犬全身炎症反应的影响  

Effects of early enteral nutrition on SIRS in dogs with acute necrotizing pancreatitis

作　　者：陈洁[1] 王兴鹏[2] 刘丕[2] 吴恺[2] 于晓峰[1] 王根生[1] 

机构地区：[1]上海市华东医院消化科,上海200040 [2]上海交通大学附属第一人民医院消化科

出　　处：《中华急诊医学杂志》2005年第9期717-721,共5页Chinese Journal of Emergency Medicine

基　　金：上海市科委重点课题(034119848)

摘　　要：目的观察早期肠内营养(EN)对急性坏死型胰腺炎(ANP)犬全身炎症反应的影响。方法经胰管内注入5%牛磺胆酸钠胰蛋白酶混合液(1ml/kg)诱导ANP犬模型。ANP犬随机分为生理盐水(NS)组(n=5),全胃肠外营养(TPN)组(n=5)和EN组(n=20);EN组中又分为十二指肠肠内高能营养多聚合剂营养组(DP)(n=5),十二指肠肠内营养混悬液营养组(DN)(n=5),空肠肠内高能营养多聚合剂营养组(JP)(n=5)和空肠肠内营养混悬液营养组(JN)(n=5)。诱导ANP后24h开始分别实施EN或TPN,维持5d。每天测定外周血淀粉酶、乳酸脱氢酶(LDH)、肿瘤坏死因子(TNF-α)、白介素-1β(IL-1β)和内毒素的含量。第7天处死动物,取胰腺组织置于中性福尔马林和液氮中保存,行HE染色观察其组织病理学改变并检测中性粒细胞髓过氧化物酶(myeloperoxydase,MPO)活性。结果(1)各组血清淀粉酶、LDH活性、胰腺组织MPO活性的差异无统计学意义(P>0·05);(2)光镜见胰腺组织炎症细胞浸润、间质出血和腺泡坏死,以NS组尤甚,EN组相对程度较轻;(3)NS、TPN组血浆内毒素水平持续上升,但第2,4,5天TPN组明显低于NS组(P<0·05),EN组同时低于NS组和TPN组,JP、JN组于第2,3,4,5天明显低于DP、DN组(P<0·05);(4)TPN、DP、DN、JP和JN组血清TNF-α、IL-1β水平均低于NS组,JP、JN组均低于TPN、DP和DN组,JP组低于JN组。结论早期肠内营养中,空肠低脂要素营养有助于减少ANP犬内毒素移位,降低血液中TNF-α、IL-1β浓度,从而减轻全身炎症反应。Objective To evaluate the effect of early enteral nutrition （EN） on systemic inflammatory response syndrome （SIRS） in dogs with acute necrotizing pancreatitis （ANP）. Methods ANP model was induced by injecting 1ml/kg of 5 % sodium taurocholate and trypsin into the pancreas via pancreatic duct. Thirty dogs were divided into TPN group （n = 5）, NS group （ n = 5）, duodenal PEPTI - 2000VARIENT group （DP） （ n = 5）, duodenal nutrition multifibre group （DN） （ n =5）, jejunal PEPTI- 2000VARIENT group （JP） （ n =5）, jejunal nutrtian multifibre group （JN） （ n =5） randomly. Dogs were treated by either saline, TPN , or EN at 24 hours after operation and lasted for 5 days. The levels of amylase, LDH, endotoxin, IL-1β and TNF-α in serum were measured everyday. Dogs were killed at 7 days. The tissue of pancreas was removed and examined by HE staining. The activity of myeloperoxidase （MPO） in pancreas was determined by zymohistochemistry. Results The serum IL-1β and TNF-α levels increased gradually in NS group; the levels were lower in TPN, DP and DN groups compared with those in NS group （ P 〈0.05）. The levels tended to further decrease in JP and JN groups and lower compared with those in NS, TPN, DP, DN groups （ P 〈0.05）. The levels in JP group were lower than in JN group （ P 〈 O. 05）. The level of plasma endotoxin increased in NS group continuously and was lower in TPN, DP and DN groups （ P 〈 0.05）. It had a tendency to further decrease in JP and JN groups, and lower compared with NS, TPN, DP, DN groups （ P 〈 0.05）. The endotoxin level was lower in JP group than in JN group （ P 〈 0.05 ）. The activity of MPO in pancreas showed no significant difference among all groups （ P 〉 0.05 ）. Conclutdon EN can decrease endotoxin translocation and alleviate the systemic inflammatory response in ANP.

关 键 词：肠内营养 急性坏死型胰腺炎 内毒素类 全身炎症反应 早期肠内营养 肿瘤坏死因子(TNF-α) 素-1β(IL-1β) 肠内营养混悬液 持续性 MPO活性 

分 类 号：R459.3[医药卫生—治疗学]