早期肠道营养对烧伤后肠源性高代谢的影响  

EFFCTS OF ENTEROGENOUS HYPERMETABOLISM ON EARLY ENTERAL FEEDING AFTER BURN INJURY

作　　者：汪仕良[1] 黎鳌[1] 尤忠义[1] 邵洪[1] 余斌[1] 朱云[1] 

机构地区：[1]第三军医大学西南医院

出　　处：《解放军医学杂志》1997年第1期18-22,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军医药卫生科研基金;国家自然科基资助

摘　　要：从８０年代末起，通过对６００只大（豚）鼠、６０只兔和６０头小香猪所建立的４种烧伤后早期营养的动物模型，以及２１例严重烧伤病人对比分析，发现烧伤后早期肠道喂养可改善胃肠道血流供应，减轻肠道缺血再灌流损伤；可维护肠粘膜结构以及吸收、分泌、运动功能，降低门脉、中心静脉血内毒素水平，减少肠道内毒素易位；可降低伤后枯否细胞获得数、吞噬墨汁枯否细胞数和面积，以及其培养上清中肿瘤坏死因子（ＴＮＦ）量，对伤后枯否细胞的活化有刺激作用；可降低血胰高糖素、皮质醇、儿茶酚胺、ＴＮＦ、ＩＬ－８前列腺素Ｅ２（ＰＧＥ２）等递质的水平，降低高代谢，使烧伤４５％成人静息能量消耗（ＲＥＥ）在烧伤后４、８、１４ｄ的均值降低２８．６％。通过相关分析发现ＲＥＥ与血丙二醛（ＭＤＡ）、内毒素、分解激素、ＴＮＦ均呈显著正相关（ｒ＝０．７３８６～０．９９２２，Ｐ＜０．０５～０．０１）。Since the end of 1980s,several new animal models were estblished,more than 600 guinea pigs and rats,60 rabbits,60 miniswines,and 21 severe cases whose TBSA were (45±12 6)% with deep burn (29 8±8 9)%,were studied.Results showed that through postburn early enteral feeding,by decreasing the ischemia and reperfusion injury of gut,the blood flow of gut mucosa and portal vein were improved;the intestinal structure and function of absorption,secretion and movement were preserved;gut endotoxin translocation,and the endotoxin level of portal and central vein were lowered.Results also showed that harvested numger of Kupffer cells(KC),counts and area of KC phagocytizing ink particles,and the content of TNF in cultured KC supernatants were all decreased,indicating the modulation effect of EEF on KC hyperactivity. The results also indicated that the level or mediators such as blood glucagon,cortisol, catecholamine,TNF,IL 8,and hypermetabolic rate were decreased after postburn EEF.There were positive correlationships between REE(resting energy expenditure)and blood or plasma level of MDA,endotoxin,catabolic hormone,TNF( r =0 7386～0 9922, P <0 05～0 01).

关 键 词：烧伤 代谢 肠道营养 

分 类 号：R644.05[医药卫生—外科学]