肠内免疫微生态营养支持对肝切除患者肝功能的影响

目的探讨肠内营养（EN）和肠内免疫微生态营养（EIN）对肝切除术后患者肝脏功能的影响。方法将82例肝切除患者随机分为两组,手术后分别接受肠内营养和肠内免疫微生态营养1周,观察两种营养方式对患者内毒素、细胞因子及肝功能的影响。结果术前EIN组内毒素、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及肝功能与EN组比较差异无统计学意义（P〉0．05）。营养支持1周后,EIN组内毒素、TNF-α和IL-6分别为（1．88±0．17）pg／ml、（260±28）pg／ml、（158±8）pg／ml,上述指标均较EN组明显下降（P〈0．01或P〈0．05）。EIN组1周后肝功能各项指标与EN组比较差异有统计学意义（P〈0．01或P〈0．05）。结论肠内免疫微生态营养,可以补充肠道正常菌群,减少细菌易位,减少内毒素血症及炎症因子的发生,从而减轻肝切除术后的肝损害。     

肠内免疫微生态营养对重症急性胰腺炎肝损害的影响

目的:探讨不同营养支持对重症急性胰腺炎肝损害的影响.方法:86例重症急性胰腺炎肝损害患者在入院48 h内随机分为3组,即肠外营养(PN)组28例,肠内营养(EN)组29例和免疫微生态肠内营养(EIN)组29例,分别行PN,EN和EIN支持14 d.检测其内毒素、细胞因子及肝功能的改变.结果:入院时EIN组内毒素、TNF-α、IL-6及肝功能与PN组、EN组比较无显著差异.营养支持14 d后,EIN组内毒素、TNF-α和IL-6分别为1.28 ng/L±0.17 ng/L,30.13 ng/L±8.12ng/L.36.43 ng/L±8.24 ng/L,上述指标均较PN组及EN组明显下降(P＜0.01或0.05).EIN组14 d后肝功能各项指标均恢复正常,与PN组、EN组比较有统计学意义(P＜0.01或0.05).结论:肠内免疫微生态营养,可以补充肠道正常菌群,减少细菌易位,减少内毒素血症及炎症因子的发生,从而减轻重症急性胰腺炎肝损害.     

肠内免疫微生态营养对重症急性胰腺炎患者内毒素、炎症因子及肝损害的影响

目的：观察肠内免疫微生态营养（EIN）对重症急性胰腺炎（SAP）患者内毒素、炎症因子及肝损害的影响。方法：将82例SAP患者随机分为治疗组和对照组,每组41例。两组均给予常规治疗,此外,对照组采用肠外营养（PN）,治疗组采用肠内免疫微生态营养（EIN）。分别在入院时及治疗7d、14d后采血测定肝功能、淀粉酶、内毒素、白介素-8（IL-8）及肿瘤坏死因子-α（TNF-α）等。结果：两组治疗后血淀粉酶、内毒素、IL-8及TNF-α水平均较治疗前明显降低（P〈0.01）,但治疗组较对照组降低更明显（P〈0.01）。治疗组在14d后肝功能各项指标均恢复正常,且与对照组比较,差异有显著统计学意义（P〈0.01）。治疗组感染率及住院时间均显著低于对照组（P〈0.05或P〈0.01）。结论：肠内免疫微生态营养能减轻内毒素血症,降低炎症因子水平,从而减轻SAP患者的肝损害。     

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20世纪90年代以来,通过对感染、创伤等严重应激状态的临床观察发现,在高代谢病理过程中或器官功能衰竭时,往往伴有免疫功能低下或障碍,感染性并发症是影响重症病人疗效的主要原因,临床给予积极的营养支持并不改善重症病人免疫功能和疾病的预后。于是,免疫营养、     

急性重症胰腺炎肠内营养支持和肠内免疫微生态营养的研究进展*

急性重症胰腺炎（severe acute pancreatitis,SAP）常伴有严重的代谢功能紊乱及营养消化吸收功能障碍,营养支持治疗可以为机体提供必需的营养物质,维护肠黏膜屏障,减少并发症的发生,对于缩短病程,改善临床转归等方面具有重要意义。近年来对于SAP营养支持的途径由完全性肠外营养转变为早期肠内营养已达成共识,关于鼻空肠管是否为最佳的喂养途径,通过鼻胃管实施肠内营养的安全性尚有诸多争论,需进一步的研究。对于肠内免疫微生态营养,目前不推荐使用添加谷氨酰胺、益生元和免疫增强配方的肠内营养。     

Effect of ecoimmunonutrition supports on maintenance of integrity of intestinal mucosal barrier in severe acute pancreatitis in dogs

Background One of the major causes of death in severe acute pancreatitis （SAP） is severe infection owing to bacterial translocation. Some clinical studies suggested that ecoimmunonutrition （EIN） as a new strategy had better treatment effect on SAP patients. But the experiment studies on the precise mechanism of the effect of EIN were less reported. In this study, we mainly investigated the effects of EIN on bacterial translocation in SAP model of dogs. Methods SAP was induced by retrograde infusion of 5% sodium taurocholate into the pancreatic duct in healthy hybrid dogs. The SAP dogs were supported with either parenteral nutrition （PN） or elemental enteral nutrition （EEN） or EIN. The levels of serum amylase, serum aminotransferase and plasma endotoxin were detected before and after pancreatitis induction. On the 7th day after nutrition supports, peritoneal fluid, mesenteric lymph nodes （MLN）, liver, and pancreas were collected for bacterial culture with standard techniques to observe the incidence of bacterial translocation. Pathology changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas, and the degree of intestinal mucosal damage was assessed by measuring mucosal thickness, villus height, and crypt depth of ileum. Results Compared with PN and EEN, EIN significantly decreased the levels of serum amylase, serum aminotransferase, plasma endotoxin, and the incidence of bacterial translocation. Furthermore, compared with the others, the histology scores of inflammation in pancreas and the ileum injury （ileum mocosa thickness, villus height, and crypt depth） were significantly alleviated by EIN （P〈0.05）. Moreover, concerning liver function, the serum levels of alanine aminotransferase, aspartate aminotransferase and albumin were ameliorating significantly in the EIN group. Conclusion Our results suggested that EIN could maintain the integrity of intestinal mucosal barrier and reducing the incidence of bacterial translocation in SAP dogs. Early EIN was safe and more effective treatment for SAP dogs.