肠内及肠外营养对梗阻性黄疸大鼠肠屏障功能的影响  

Effects of enteral nutrition and parenteral nutrition on bowel barrier function in rats with obstructive jaundice

作　　者：陈光[1] 罗金石[1] 付学广[1] 任江[1] 胡毕文[1] 董丙飞[1] 王广义[1] 谭毓铨[1] 

机构地区：[1]吉林大学第一医院普通外科,吉林长春130021

出　　处：《吉林大学学报（医学版）》2007年第1期112-115,共4页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅基金资助课题(200205231)

摘　　要：目的:比较肠内营养(EN)及肠外营养(PN)对阻塞性黄疸(OJ)大鼠肠黏膜屏障功能的影响。方法:结扎胆总管建立OJ大鼠模型。60只SD大鼠随机分为A组:假手术组(SHAM),B组:梗黄组(CBDL),C组:梗黄肠外营养组(CBDL+PN),D组:梗黄肠内营养组(CBDL+EN),E组:梗黄抗生素自由饮水组,每组12只,饲养1周后采腔静脉血分离血清待测内毒素;取肠系膜淋巴结、肝脾少量培养后观察记录细菌生长情况。取小肠制作切片光镜观察小肠黏膜形态学变化及绒毛高度、厚度和隐窝深浅等。结果:与A组比较,B组及D组空肠黏膜隐窝深度变浅(P<0.05),C组及E组大鼠空肠黏膜亦有不同程度变薄、萎缩、绒毛变短、隐窝变浅等;A组无肠系膜淋巴结细菌移位,B、C、D和E组肠系膜淋巴结细菌移位率高于A组(P<0.05或P<0.01);B、C、D和E组血内毒素含量高于A组(P<0.05或P<0.01),E组低于B、C和D组(P<0.05)。结论:①OJ时肠道屏障功能受损,发生细菌移位及内毒素血症;②肠内及标准肠外营养都不能维持OJ大鼠肠黏膜屏障及阻止肠道细菌移位,但肠内营养组好于肠外营养组;③肠道抗生素可降低内毒素血症的发生率及有利于阻止细菌移位。Objective To compare the effects of enteral nutrition （EN） and parenteral nutrition （PN） on bowel mucosal barrier function in rats with obstructive jaundice. Methods By common biliary duct ligating, the obstructive jaundice rat models were set up. Sixty SD rats were randomly divided into group A： sham operation （SHAM）, group B： common biliary duct llgating （CBDL）, group C： CBDL＋TPN, group D： CBDL＋EN, group E： CBDL＋ freedom drinking water with antibiotic, 12 rats in each group. After the rats were bred for 1 week,the caval vein blood was got and the serum was separated to wait for the measuring of endotoxin. The mesenterie lymph node, liver and spleen were obtained, cultivated, observed and the condition of bacterium growth were recorded. The small intestine was gained to make microtome section and mucous membrane of small intestine morphology, trophonema altitude, thickness and crypt shade were observed under light microscope. Results Compared with group A, jejunal mucous intestinal membrane depths in groups B and D were shallow （P〈 0.05）, rat jejunal mucous intestinal membrane in group C and E became thinner and atrophy, and had shortened villus and shallower cave. There was no lymphnode mesenterici bacteria transposal in group A, the lymph node mesenterici bacteria transposal rates in groups B, C, D and E were higher than that in group A （P〈0.01 or P〈 0.05）. The contents of endotoxin in group B, C, D and E were higher than that in group A （P〈0.01 or P〈 0.05）, it was lower in group E than those in groups B, C and D （P〈0.05）. Conclusion （1）When intestinal barrier is injuried, bacteria transposal and endotoxemia exist in obstructive jaundice; （2）Both EN and standard PN can not maintain intestinal membrane barrier and hold up the occurrence of intestinal bacteria transposal in obstructive jaundice rats, but the effect of EN is better than PN; （3）Intestinal tract antibiotics can step down incidence rate of endotoxemia and profit to hold up the o

关 键 词：阻塞性黄疸 肠内营养 肠外营养 内毒素 细菌移位 

分 类 号：R575[医药卫生—消化系统] R459.3[医药卫生—内科学]