中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2015年
5期
390-394
,共5页
倪俊%严强%袁文斌%岑峰%张国雷%顾凤元
倪俊%嚴彊%袁文斌%岑峰%張國雷%顧鳳元
예준%엄강%원문빈%잠봉%장국뢰%고봉원
重症急性胰腺炎%营养支持治疗,肠内%炎症因子%核转录因子kappa B
重癥急性胰腺炎%營養支持治療,腸內%炎癥因子%覈轉錄因子kappa B
중증급성이선염%영양지지치료,장내%염증인자%핵전록인자kappa B
Severe acute pancreatitis%Nutritional support therapy,enteral%Inflammatory factor%Nuclear factor-kappa B
目的 探讨肠内营养支持治疗时机的选择对重症急性胰腺炎(SAP)的作用.方法 采用健康清洁级长白山大白兔构建SAP模型,将建模成功的40只SAP大白兔按随机数字表法分为两组,每组20只.(1)实验组:行肠外营养支持治疗,听诊肠鸣音恢复后行肠内营养支持治疗;(2)对照组:行肠外营养支持治疗12 h后即行肠内营养支持治疗.检测建模后第1、3、7天血清TNF-α、IL-6、IL-8水平;检测肠内营养支持治疗前1h、肠内营养支持治疗后第1、3天腹内压;于建模后第7、10天处死实验动物,免疫组织化学染色检测胰腺组织核转录因子-κB(NF-κB)表达,并对肠系膜淋巴结进行细菌培养.正态分布的计量资料以(x)±s表示,组间趋势比较采用重复测量方差分析,两两比较采用t检验.结果 成功建立40只SAP大白兔模型.(1)血清学指标:建模后第1、3、7天,实验组TNF-α分别为(6.9±2.1)ng/L、(5.9±1.8)ng/L、(5.3±1.8)ng/L;IL-6分别为(109±17) ng/L、(96±16) ng/L、(83±17) ng/L;IL-8分别为(89±20) ng/L、(78±21) ng/L、(70±19) ng/L.对照组TNF-α分别为(7.4±1.5)ng/L、(7.1±1.6)ng/L、(6.8±1.7) ng/L;IL-6分别为(101±19) ng/L、(98±18) ng/L、(93±20) ng/L;IL-8分别为(91±14)ng/L、(91±16) ng/L、(83±19) ng/L.两组TNF-α、IL-6的变化趋势比较,差异均有统计学意义(F =7.947,19.386,P＜0.05),IL-8差异则无统计学意义(F =2.756,P＞0.05).(2)腹内压:肠内营养支持治疗前、肠内营养支持治疗后第1、3天实验组腹内压分别为(3.5±1.6) cmH2O(1 cmH2O=0.098 kPa)、(4.3±1.7) cmH2O、(3.6±1.8) cmH2O;对照组腹内压分别为(4.9±1.9)cmH2O、(5.7±2.2) cmH2O、(4.5±1.6) cmH2O,两组比较,差异有统计学意义(F=7.042,P＜0.05).(3)胰腺组织NF-κB:细胞质及细胞核中均有NF-κB表达,以细胞核表达为主,实验组第7天的NF-κB表达强度为5.0±2.7,低于对照组的7.0±2.9,两组比较,差异有统计学意义(t=2.236,P＜0.05).(4)肠系膜淋巴结细菌培养:建模后第7、10天实验组分别为(4.7±0.9)×103 cfu/g、(4.1±0.7) ×103 cfu/g,对照组分别为(5.5±1.0)×103 cfu/g、(4.6±0.7)×103 cfu/g,两组比较,差异均有统计学意义(t =2.382,2.126,P＜0.05).结论 肠内营养支持治疗时机的选择对SAP的恢复具有重要意义,而肠功能恢复后行肠内营养支持治疗可能更优于直接行肠内营养支持治疗.
目的 探討腸內營養支持治療時機的選擇對重癥急性胰腺炎(SAP)的作用.方法 採用健康清潔級長白山大白兔構建SAP模型,將建模成功的40隻SAP大白兔按隨機數字錶法分為兩組,每組20隻.(1)實驗組:行腸外營養支持治療,聽診腸鳴音恢複後行腸內營養支持治療;(2)對照組:行腸外營養支持治療12 h後即行腸內營養支持治療.檢測建模後第1、3、7天血清TNF-α、IL-6、IL-8水平;檢測腸內營養支持治療前1h、腸內營養支持治療後第1、3天腹內壓;于建模後第7、10天處死實驗動物,免疫組織化學染色檢測胰腺組織覈轉錄因子-κB(NF-κB)錶達,併對腸繫膜淋巴結進行細菌培養.正態分佈的計量資料以(x)±s錶示,組間趨勢比較採用重複測量方差分析,兩兩比較採用t檢驗.結果 成功建立40隻SAP大白兔模型.(1)血清學指標:建模後第1、3、7天,實驗組TNF-α分彆為(6.9±2.1)ng/L、(5.9±1.8)ng/L、(5.3±1.8)ng/L;IL-6分彆為(109±17) ng/L、(96±16) ng/L、(83±17) ng/L;IL-8分彆為(89±20) ng/L、(78±21) ng/L、(70±19) ng/L.對照組TNF-α分彆為(7.4±1.5)ng/L、(7.1±1.6)ng/L、(6.8±1.7) ng/L;IL-6分彆為(101±19) ng/L、(98±18) ng/L、(93±20) ng/L;IL-8分彆為(91±14)ng/L、(91±16) ng/L、(83±19) ng/L.兩組TNF-α、IL-6的變化趨勢比較,差異均有統計學意義(F =7.947,19.386,P＜0.05),IL-8差異則無統計學意義(F =2.756,P＞0.05).(2)腹內壓:腸內營養支持治療前、腸內營養支持治療後第1、3天實驗組腹內壓分彆為(3.5±1.6) cmH2O(1 cmH2O=0.098 kPa)、(4.3±1.7) cmH2O、(3.6±1.8) cmH2O;對照組腹內壓分彆為(4.9±1.9)cmH2O、(5.7±2.2) cmH2O、(4.5±1.6) cmH2O,兩組比較,差異有統計學意義(F=7.042,P＜0.05).(3)胰腺組織NF-κB:細胞質及細胞覈中均有NF-κB錶達,以細胞覈錶達為主,實驗組第7天的NF-κB錶達彊度為5.0±2.7,低于對照組的7.0±2.9,兩組比較,差異有統計學意義(t=2.236,P＜0.05).(4)腸繫膜淋巴結細菌培養:建模後第7、10天實驗組分彆為(4.7±0.9)×103 cfu/g、(4.1±0.7) ×103 cfu/g,對照組分彆為(5.5±1.0)×103 cfu/g、(4.6±0.7)×103 cfu/g,兩組比較,差異均有統計學意義(t =2.382,2.126,P＜0.05).結論 腸內營養支持治療時機的選擇對SAP的恢複具有重要意義,而腸功能恢複後行腸內營養支持治療可能更優于直接行腸內營養支持治療.
목적 탐토장내영양지지치료시궤적선택대중증급성이선염(SAP)적작용.방법 채용건강청길급장백산대백토구건SAP모형,장건모성공적40지SAP대백토안수궤수자표법분위량조,매조20지.(1)실험조:행장외영양지지치료,은진장명음회복후행장내영양지지치료;(2)대조조:행장외영양지지치료12 h후즉행장내영양지지치료.검측건모후제1、3、7천혈청TNF-α、IL-6、IL-8수평;검측장내영양지지치료전1h、장내영양지지치료후제1、3천복내압;우건모후제7、10천처사실험동물,면역조직화학염색검측이선조직핵전록인자-κB(NF-κB)표체,병대장계막림파결진행세균배양.정태분포적계량자료이(x)±s표시,조간추세비교채용중복측량방차분석,량량비교채용t검험.결과 성공건립40지SAP대백토모형.(1)혈청학지표:건모후제1、3、7천,실험조TNF-α분별위(6.9±2.1)ng/L、(5.9±1.8)ng/L、(5.3±1.8)ng/L;IL-6분별위(109±17) ng/L、(96±16) ng/L、(83±17) ng/L;IL-8분별위(89±20) ng/L、(78±21) ng/L、(70±19) ng/L.대조조TNF-α분별위(7.4±1.5)ng/L、(7.1±1.6)ng/L、(6.8±1.7) ng/L;IL-6분별위(101±19) ng/L、(98±18) ng/L、(93±20) ng/L;IL-8분별위(91±14)ng/L、(91±16) ng/L、(83±19) ng/L.량조TNF-α、IL-6적변화추세비교,차이균유통계학의의(F =7.947,19.386,P＜0.05),IL-8차이칙무통계학의의(F =2.756,P＞0.05).(2)복내압:장내영양지지치료전、장내영양지지치료후제1、3천실험조복내압분별위(3.5±1.6) cmH2O(1 cmH2O=0.098 kPa)、(4.3±1.7) cmH2O、(3.6±1.8) cmH2O;대조조복내압분별위(4.9±1.9)cmH2O、(5.7±2.2) cmH2O、(4.5±1.6) cmH2O,량조비교,차이유통계학의의(F=7.042,P＜0.05).(3)이선조직NF-κB:세포질급세포핵중균유NF-κB표체,이세포핵표체위주,실험조제7천적NF-κB표체강도위5.0±2.7,저우대조조적7.0±2.9,량조비교,차이유통계학의의(t=2.236,P＜0.05).(4)장계막림파결세균배양:건모후제7、10천실험조분별위(4.7±0.9)×103 cfu/g、(4.1±0.7) ×103 cfu/g,대조조분별위(5.5±1.0)×103 cfu/g、(4.6±0.7)×103 cfu/g,량조비교,차이균유통계학의의(t =2.382,2.126,P＜0.05).결론 장내영양지지치료시궤적선택대SAP적회복구유중요의의,이장공능회복후행장내영양지지치료가능경우우직접행장내영양지지치료.
Objective To explore the effects of timing of enteral nutrition (EN) in the severe acute pancreatitis (SAP).Methods The rabbit model of SAP was constructed,and 40 experimental rabbits were divided randomly into the experimental group (20 rabbits) and the control group(20 rabbits).(1) The parenteral nutrition (PN) was administered to rabbits in the experimental group,and then EN was administered after bowel sound restoration.(2) EN was administered to the rabbits in the control group at hour 12 after PN.The values of TNF-α,IL-6 and IL-8 on post-modeling day 1,3 and 7 and intra-abdominal pressures at hour 1 before EN and on post-modeling day 1 and 3 were respectively examined.The experimental animals were sacrificed on post-modeling day 7 and 10.The expression of nuclear factor-kappa B (NF-κB) was detected by immunohistochemistry and bacteria from mesenteric lymph nodes were cultured.The measurement data with normal distribution were presented as (x) ± s.The trend comparison between groups and pairwise comparison were analyzed using the repeated measures ANOVA and t test.Results The 40 rabbit models of SAP were constructed successfully.(1) The results of serum test showed that the values of TNF-α,IL-6 and IL-8 in the experimental group on post-modeling day 1,3and 7 were (6.9 ±2.1)ng/L,(5.9 ± 1.8) ng/L,(5.3 ± 1.8) ng/L and (109 ± 17) ng/L,(96 ± 16) ng/L,(83 ± 17)ng/L and (89 ±20)ng/L,(78 ±21)ng/L,(70 ± 19)ng/L,respectively.The values of TNF-α,IL-6 and IL-8 in the control group on post-modeling day 1,3 and 7 were (7.4 ± 1.5) ng/L,(7.1 ± 1.6) ng/L (6.8 ±1.7) ng/L and (101 ± 19) ng/L,(98 ± 18) ng/L,(93 ±20) ng/L and (91 ± 14) ng/L,(91 ± 16) ng/L,(83 ±19)ng/L,respectively.There were significant differences in the changing trends of TNF-α and IL-6 between the 2 groups (F =7.947,19.386,P ＜ 0.05),with no significant difference in the changing trend of IL-8 between the 2 groups (F =2.756,P ＞ 0.05).(2)The intra-abdominal pressures in the experimental group at hour 1 before EEN and on post-modeling day 1 and 3 were (3.5 ± 1.6) cmH2O (1 cmH2O =0.098 kPa),(4.3 ± 1.7) cmH2Oand (3.6 ± 1.8) cmH2O,which were significantly different from (4.9 ± 1.9) cmH2O,(5.7 ± 2.2) cmH2O and (4.5 ± 1.6)cmH2O in the control group (F =7.042,P ＜0.05).(3) The expression of NF-κB in the tissues of pancreas was localized mainly in the cell nucleus.The expression of NF-κB in the experimental group on postmodeling day 7 was 5.0 ± 2.7,which was significantly different from 7.0 ± 2.9 in the control group (t =2.236,P ＜ 0.05).(4) The amount of bacteria culture from mesenteric lymph nodes in the experimental group on postmodeling day 7 and 10 were (4.7 ±0.9) × 103 cfu/g and (4.1 ±0.7) × 103 cfu/g,which were significantly different from (5.5 ± 1.0) × 103 cfu/g and (4.6 ± 0.7) × 103 cfu/g in the control group (t =2.382,2.126,P ＜0.05).Conclusion The selective timing of EN can effectively improve the recovery of rabbits with SAP,and the efficacy of EN administering based on the recovery of bowel function may be better than immediate EN administering.
