胆肠内引流术后早期肠内、肠外营养对大鼠肠免疫屏障功能及内毒素的影响

目的建立一种简易的胆肠内引流大鼠模型，比较术后早期肠内营养（Enteral nutrition，EN）、肠外营养（Parental nutrition，PN）对大鼠肠免疫屏障功能及门静脉血内毒素水平的影响。方法普通级雄性Wistar大鼠30只随机分为对照组、PN组和EN组，每组10只，采用不同的营养途径。建立模型成功后7d，切取距盲肠3cm处的回肠2cm，用流式细胞仪技术检测各组肠黏膜CD4＋、CD8＋T淋巴细胞的百分率及CD4＋、CD8＋的比值。同时取门静脉血测定内毒素水平。结果与对照组和PN组相比，EN组大鼠的肠黏膜CD4＋淋巴细胞的百分率以及CD4／CD8比值有明显的升高（P〈0．05）；EN组实验动物门静脉血内毒素水平明显低于对照组和PN组。结论梗阻性黄疽内引流术后早期肠内营养不但对肠道黏膜屏障功能，而且对肠道本身的免疫屏障功能有较好的保护作用，对减少术后肠源性感染有一定的作用。

Effects of early enteral and parenteral nutrition after biliary enterostomy on the intestinal immune barrier and endotoxin of rats

Objective To compare the effects of early enteral nutrition （EN） and parenteral nutrition（PN） after biliary enterostomy on the intestinal immune barrier and endotoxin by establishing a simple animal model. Methods 30 male Wistar rats were randomly divided into 3 groups, the control, EN and PN groups, 10 rats for each group, and different nutritional routes employed. 7 days after animal model establishment, 2 cm ileum in length 3 cm away from cecum were resected, CD4＋, CD8＋ T lymphocytes were detected by flow cytometry technique, portal vein blood was taken simultaneously to detect endotoxin. Resulst Comparing with control and PN groups, the percentage of CD4＋T lymphocytes and CD4/CD8 of EN group were higher（P〈 0.05）; its portal vein endotoxin level significantly lower than that of the formers. Conclusion Early EN after biliary enterostomy for obstructive jaundice has protective effects on intestinal immune defense. It is helpful to decrease postoperative intestinal derived infection.