早期肠道喂养在降低烧伤后肠黏膜通透性中的作用  

Effects of Early Enteral Feeding on the Preservation of Intestinal Mucosal Barrier in Severely Burned Patients

作　　者：彭毅志[1] 袁志强[1] 肖光夏[1] 

机构地区：[1]第三军医大学西南医院烧伤研究所,重庆400038

出　　处：《中国医师杂志》2003年第11期1474-1476,共3页Journal of Chinese Physician

摘　　要：目的　研究早期肠道喂养在保护烧伤患者肠黏膜屏障中的作用。方法　 2 2例严重烧伤患者随机分为早期肠道喂养组 (EF)和延迟肠道喂养组 (DF)。动态检测了两组患者伤后血浆TNF -α和内毒素水平 ;同时采用两种非代谢糖类 (乳果糖和甘露醇 ) ,在伤后 1、3、5d给予口服 ,观察尿中的浓度及两者比值 ,以后者表示肠黏膜通透性。结果　烧伤后血浆内毒素和TNF -α水平均明显高于正常 (P <0 0 1) ;两组中TNF -α与内毒素水平呈显著正相关 (rEF=0 93 ,P <0 0 1;rDF=0 80 ,P <0 0 5 ) ;两组患者尿乳果糖含量明显高于正常 (P <0 0 1) ,尿甘露醇含量无明显改变 ;尿乳果糖 /甘露醇比值均明显高于正常 (P <0 0 1) ,尿乳果糖 /甘露醇比值与血浆内毒素水平呈显著正相关 (r =0 95 ,P <0 0 1) ;EF组尿乳果糖含量和尿乳果糖 /甘露醇比值均明显低于DF组 ( P <0 0 1) ,血浆TNF -α和内毒素水平也明显低于DF组。结论　严重烧伤后肠黏膜通透性明显升高 ,且与严重烧伤后肠源性内毒素血症相关。早期肠道喂养可降低肠黏膜通透性 。Objective To study the effects of early enteral feeding on the preservation of intestinal mucosal barrier in severely burned patients. Methods Twenty-two patients with severe burn were randomly divided into early enteral feeding group (EF) and delayed enteral feeding group (DF). The levels of serum endotoxin and TNF-α were dynamically detected in the patients of both groups, and two unmetabolized sugars (lactose and mannitol) were orally administered in these patients on 1d, 3d and 5d of postburn. The concentrations of lactose and mannitol in urinary and the L/M ratio were observed. Intestinal permeability was assessed by the L/M ratio. Results The levels of serum endotoxin and TNF-α in severely burned patients were significantly higher than in normal (P<0 01). The endotoxin level was positively related to the TNF-α level (r EF =0 93, P<0 01; r DF =0 80, P<0 05). The urinary lactose level in both groups was significantly higher than that in normal (P<0 01), and the urinary mannitol level had not obvious change. The urinary L/M ratio in both groups were significantly higher than normal range (P<0 01). The urinary L/M ratio was positively related to the serum endotoxin level (r=0 95, P<0 01). The urinary lactose level and the urinary L/M ratio in EF group were significantly lower than those in DF group (P<0 01), and the levels of serum endotoxin and TNF-α in the former were also lower than those in the latter. Conclusions After burn, the intestinal permeability was markedly higher than normal, and was positively related to the gut-derived endotoxemia. Early enteral feeding may decrease the intestinal permeability and preserve the intestinal mucosal barrier.

关 键 词：早期肠道喂养 肠黏膜屏障 烧伤 

分 类 号：R644[医药卫生—外科学]