Impact of enteral nutrition on intestinal bacterial translocation and mortality in burned mice

The aim of these experiments was to study the effect of early enteral nutrition with either standard or enriched (arginine, n-3 fatty acids, RNA) enteral formulas on translocation of bacteria from the gut and acute mortality rate following thermal injury. In the first experiment 60 Balb c mice were gavaged with 10(10)Escherichia coli and received a 20% burn injury. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after injury and stopped 36 h later. In the control group (n = 20) aliquotes of Ringer's solution was administered intragastrically. Mortality rate was observed for 10 days post-injury. In the second experiment 60 Balb c mice were gavaged with 10(10)E. coli labelled with biotin(111) Indium and then burned. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after burn. The control group (n = 20) received aliquotes of Ringer's solution. 4 h after injury all animals were sacrificed and liver, lungs, kidneys, spleen and systemic blood were harvested, and radionuclide counts were measured. No animal died after day 3 post-burn. The mortality rate was significantly lower at day 1 in the groups infused with both enteral solutions (15%) compared to controls (30%; p = 0.05). At day 3 the animals fed with the enriched diets showed a lower mortality (5%) versus the standard and control groups (10%). Bacterial translocation to the liver and lungs was significantly higher in Ringer's group than in both enterally fed groups. Early post-burn enteral nutrition reduces both translocation and acute mortality. Supplementation of the diets with specific nutrients appears to exert additional advantages on outcome.     

生态免疫肠内营养支持对高位肠瘘病人免疫和肠黏膜屏障功能的影响

目的:探讨生态免疫肠内营养(EIEN)支持对高位肠瘘病人免疫和肠黏膜屏障功能的影响. 方法:将47例病人随机分为EIEN组(n=24)和肠外营养(PN)组(n=23),分别给予等氮、等热量的营养支持治疗.两组病人营养支持前和支持后第7和14天分别检测T淋巴细胞亚群、营养指标、血D-乳酸水平和血内毒素水平的变化. 结果:与营养支持前比,两组病人营养支持后第7天血D-乳酸水平和血内毒素水平明显降低(P＜0.05);营养支持后第14天,两组病人营养指标和CD3、CD4阳性细胞数及CD4/CD8比值基本恢复至正常水平;EIEN组血D-乳酸水平和血内毒素水平基本恢复正常水平,且与PN组比较有显著性差异(P＜0.05). 结论:EIEN支持有助于改善高位肠瘘病人的营养状况、免疫功能和肠黏膜屏障功能,促进机体的康复.     

免疫肠内营养对重症急性胰腺炎病人肠黏膜屏障和细胞因子的影响

目的:探讨免疫肠内营养(IEN)治疗对重症急性胰腺炎(SAP)病人肠黏膜屏障和细胞因子的影响.方法:将46例病人随机分为IEN组和对照组,每组23例.对照组病人采用传统保守治疗,IEN组在保守治疗基础上给予IEN治疗.观察两组病人住院期间血、尿淀粉酶恢复时间,腹痛缓解时间和两组间的并发症、治愈等情况以及细胞因子和肠黏膜屏障功能的变化. 结果:两组病人腹痛缓解时间、血和尿淀粉酶变化、并发症的发生率和治愈率等比较均有显著性差异(P＜0.05).治疗前、治疗后第7和第14天分别检测T淋巴细胞亚群(CD3+、CD4+、CD8+和CD4+/CD8+)、炎性细胞因子(TNF-α、IL-6、IL-8)、血D-乳酸和内毒素水平变化均有显著性差异(P＜0.05).绪论:IEN可改善SAP病人的肠黏膜屏障功能和细胞因子功能.     

Influence of polymeric enteral nutrition supplemented with different doses of glutamine on gut permeability in critically ill patients

OBJECTIVES: To evaluate the effect of glutamine-supplemented polymeric enteral formulas on the recovery of gut-permeability abnormalities in critically ill patients. METHODS: Twenty-three patients were randomized to receive a conventional casein-based enteral formula (ADN), ADN plus glutamine in a dose of 0.15 g x kg(-1) x d(-1) or ADN plus 0.30 g x kg(-1) x d(-1) of glutamine for 8 d. The lactulose mannitol permeability test (L/M) was performed at baseline and at the end of the study. Nineteen healthy volunteers served as controls for the L/M test. RESULTS: An increase in permeability compared with control subjects was observed in patients at baseline (mean +/- standard error of the mean; L/M ratio: 0.11 +/- 0.03 and 0.025 +/- 0.004, respectively; P < 0.02). The L/M ratio improved after the period of enteral nutrition as a whole (initial L/M: 0.11 +/- 0.03, final L/M: 0.061 +/- 0.01; P < 0.03), but no difference was found between groups. CONCLUSIONS: Even though polymeric enteral nutrition was associated with a significant improvement in the L/M ratio, glutamine supplementation did not show a specific influence in improving recovery of gut permeability in critically ill patients.     

早期肠道营养对烧伤后大鼠肠粘膜能量合成的影响

目的：探讨早期肠道营养对肠道本身能量合成的影响。方法：至Wistar大鼠总体表面积（TBSA）30％三度烧伤，随机将动物分为早期喂养组（EF）、延迟喂养组（DF）和正常对照组。采用高效液相色谱法检测肠粘膜组织ATP、ADP和AMP，按公式计算能量负荷。结果：EF和DF组的ATP、ADP含量在伤后均明显低于对照组（P＜0．01），而AMP的含量均明显高对照组（P＜0．01），EF组与DF组相比，EF组的ATP、ADP含量明显高于DF组（P＜0．01－0．05），而AMP含量明显低于DF组。两组能量负荷均下降，以伤后24h最为显著。除伤后6h外，EF组能量负荷均显著高于DF组。结论：烧伤后肠粘膜高能磷酸化合物明显减少，反映细胞能量贮备的能量负荷水平明显下降，早期肠道喂养可明显增加大鼠肠粘膜能量贮备。     

Maintaining mucosal immunity during parenteral feeding with surrogates to enteral nutrition.

Pneumonia and intra-abdominal abscesses are significantly lower in trauma patients receiving enteral feeding compared with those receiving parenteral feeding. Extensive experimental evidence suggests that this is related to maintenance of the mucosal-associated lymphoid tissue, which provides immunologic protection for both the gastrointestinal and respiratory tracts against microbial flora and infectious pathogens. This system is exquisitely sensitive to the route and type of nutrition delivery that affects its functional effectiveness. Although parenteral nutrition decreases the effectiveness of this extraintestinal mucosal immunity, specialty nutrients like glutamine and neuropeptides such as gastrin-releasing peptide and cholecystokinin are capable of preventing some of the immune defects associated with parenteral nutrition. This review examines the mechanisms associated with the mucosal immunity and role of both glutamine and neuropeptides in normalizing defects induced by parenteral feeding. Based upon evolving data, specific nutrients and products of the enteric nervous system show promise as adjuncts to parenteral feeding that are capable of maintaining immune function in patients unable to be fed via the gastrointestinal tract.     

谷氨酰胺保护严重烧伤病人肠粘膜屏障功能的研究

目的：观察严重烧伤病人肠粘膜屏障功能的变化及口服谷氨酰胺颗粒剂对它的影响。方法：采用随机双盲对照法,将烧伤总面积在30％－60％、三度烧伤面积在10％－30％的39例病人,随机分为谷氨酰胺治疗组（Gln组20例）和安慰剂对照组（C组19例）。Gln组每天服用谷氨酰胺颗粒剂0．5g/kg。C组服用同等剂量的安慰剂,疗程为7天。检测用药前后两组病人血中谷氨酰胺浓度、二胺氧化酶（DAO）活性、内毒素含量及肠粘膜通透性的变化,并记录一般情况和住院日。结果：Gln组病人用药7天后,血中谷氨酰胺含量明显高于C组（P＜0．01）,而血浆DAO活性、内毒素含量及肠粘膜通透性均显著低于C组（P＜0．01）,住院日显著短于C组。结论：服用谷氨酰胺颗粒剂能显著提高严重烧伤病人血中谷氨酰胺水平,减轻伤后肠道受损程度,保护肠粘膜屏障,并有助于缩短住院日。     

Effects of parenteral nutrition supplemented with glutamine or glutamine dipeptides on liver antioxidant and detoxication systems in rats

Our aim was to determine the effects of glutamine or alanyl glutamine parenteral supplementation on the liver oxidant/antioxidant balance and on cytochrome-P450-mediated detoxication in rats. Animals were infused for 5 d with standard total parenteral nutrition (TPN), glutamine-enriched TPN, or alanyl glutamine-enriched TPN. The hepatic concentration of glutathione was reduced, and the levels of thiobarbituric-acid-reactive substances (TBARS) were increased in animals receiving standard TPN. Both glutamine and alanyl glutamine supplementation normalized glutathione, but thiobarbituric-acid-reactive substance concentration was only decreased by ananyl glutamine. This effect was parallel to a partial recovery of the activity of antioxidant enzymes. Cytochrome-P450 liver content, cytochrome-P450-dependent monooxygenases, and antipyrine clearance were not modified by glutamine or alanyl glutamine. Our data suggest a better protection against free radicals by alanyl glutamine supplementation and an absence of effects of both glutamine and alanyl glutamine on liver oxidative metabolism.     

肠康复治疗对短肠综合征病人残余小肠黏膜形态学的影响

目的:观察重组人生长激素(rhGH)、谷氨酰胺(Gln)和膳食纤维的肠内营养(EN)对短肠综合征病人小肠黏膜形态、肠黏膜细胞增殖和凋亡水平的改变,以评价对短肠综合征病人的治疗效果. 方法:10例短肠综合征病人联合应用rhGH 0.05 mg/(kg·d)、Gln 30 g/d和膳食纤维的EN进行3周的肠康复治疗.分别在...     

经肠道补充精氨酸对严重烧伤家兔免疫功能的影响

目的 :研究精氨酸对烧伤家兔免疫功能的影响及其机制。　方法 :采用 30 %体表面积三度烧伤家兔模型。将 2 6只日本长耳白兔随机分成三组 :即正常对照组 (n =8)、烧伤对照组 (n =9)和精氨酸喂养组 (n =9)。精氨酸组给予醋酸精氨酸 1.2g/ (kg·d) (精氨酸净重 0 .89g) ,烧伤对照组给予等量的酪氨酸 ,观察给药 7天后精氨酸对烧伤家兔免疫功能的影响。　结果 :烧伤 7天后两组动物免疫功能均明显下降 ,两组相比 ,精氨酸组家兔免疫功能明显优于烧伤对照组 ,各项免疫指标的变化均有显著意义 ,淋巴细胞转化率为 (5 8.4 4± 5 .2 0 ) %vs.(48.0 0± 3.2 8) % ,P<0 .0 1;白细胞吞噬率为 (30 .5 6± 3.13) %vs.(2 2 .33± 3.71) % ,P <0 .0 1;白细胞趋化指数为 1.92± 0 .35vs.1.6 1± 0 .16 ,P <0 .0 1;CD4 /CD8比值为 :1.4 2± 0 .10vs.1.0 2± 0 .12 ,P <0 .0 1;血浆IgG含量为 8.10± 1.2 2 )g/Lvs.(5 .5 1± 1.6 2 )g/L ,P <0 .0 1;IgM为 (1.2 2± 0 .2 2 )g/Lvs.(0 .6 1± 0 .15 )g/L ,P <0 .0 1;动物病死率也明显降低 ,为 10 .0 0 %vs.35 .71% ,P <0 .0 1。　结论 :严重烧伤家兔机体免疫功能下降 ,经肠道补充精氨酸能有效提高烧伤后免疫功能 ,降低动物死亡率     

肠内营养对活动期溃疡性结肠炎患者肠道通透性的影响

目的 探讨肠内营养(EN)对活动期溃疡性结肠炎患者肠道通透性的影响。方法 采用随机数字表法将24例轻、中度活动期溃疡性结肠炎患者分为常规组(n=11)和常规+ EN组(n=13),分别给予美沙拉秦+少渣饮食治疗和美沙拉秦+短肽型肠内营养剂治疗14 d。采用高压液相色谱分析法分别检测治疗前后患者尿液中乳果糖及甘露醇的浓度,计算乳果糖/甘露醇排泄率的比值(L/M)。结果 治疗前常规组和常规+ EN组的L/M分别为0.039±0.025和0.072±0.019,两组的差异无统计学意义(P=0.069)。治疗2周后,常规+EN组的L/M为0.038±0.012,明显低于治疗前(P =0.043),常规组的L/M为0.032±0.022,与治疗前的差异无统计学意义(P=0.730)。结论 EN可以降低活动期溃疡性结肠炎患者的肠道通透性。     

Plasma concentrations of vasoactive intestinal polypeptide in severely burned patients: influence of enteral nutrition

Plasma vasoactive intestinal polypeptide (VIP) concentrations were measured at different days after burn injury. A significant decrease in VIP levels was observed on days 7 and 10. The influence of enteral nutrition was also investigated: a rise in plasma polypeptide levels was found at 60 min after nutrition restart on days 4 and 7 after injury. In burn patients, VIP may be involved in the multiple metabolic and hormonal responses which lead to an increase in the hypercatabolic state. The decrease in these polypeptide values should reflect enhanced utilisation or complex hormonal regulation. After enteral nutrition, the stimulation of VIP secretion disappeared after day 7 after burn injury. This phenomenon is probably mediated by a process of adaptation to continuous enteral nutrition.     

谷氨酰胺强化肠外营养在外科危重患者中的作用

目的:探讨全胃肠外营养(TPN)加丙胺酰-谷氨酰胺注射液对外科危重症患者营养及免疫功能的影响。方法:将94例外科重症需要TPN的患者随机分为治疗组和对照组,均给予8dTPN治疗,其中治疗组患者每天加用丙胺酰-谷氨酰胺注射液0.4g/kg。检测患者TPN前、TPN后2d及8d的营养及免疫指标并进行分析。结果:治疗组、对照组与TPN前比较,TPN后2d血清ALB、PAB、TRF水平、PNI均有不同程度恢复,CD4的百分比、CD4/CD8比值、IgG、IgA、IgM有不同程度下降,治疗组优于对照组,在TPN后8d两组比较差异有统计学意义(t=2.235,t=2.167;P<0.05);而CD8的百分比与上述相反(t=2.178,P<0.01)。结论:外科危重症患者在TPN治疗基础上加用丙胺酰-谷氨酰胺注射液能有效改善机体营养和免疫状况,从而促进预后。     

不同营养支持及手术应激对肠道粘膜免疫功能的影响

目的 :　通过观察肠内营养 (EN)、肠外营养 (PN)以及上腹部大手术 (MO)后应激病人外周血IgA、IgA分泌片 (SC片 )、D 乳酸、C反应蛋白 (CRP)变化 ,了解不同营养支持及手术应激状态下肠道粘膜免疫的变化。　方法 :　连续监测 79例无感染的EN、PN、MO病人的外周血白蛋白、IgA、SC片段以及D 乳酸、CRP浓度变化。对照组为新近入院的诊断为腹股沟斜疝和胆囊息肉病人 (n =10 )。　结果 :　四组血清蛋白水平无显著差异。血IgA水平 :EN组与对照组相当 (P >0 .0 5 ) ,EN组明显高于PN、MO组 (P <0 0 1) ,MO组高于PN组 (P <0 0 5 ) ;外周血SC片段水平 :EN、MO与对照组水平相当 (P >0 .0 5 ) ,PN明显下降 (P <0 0 1) ;外周血D 乳酸水平 :PN组明显高于EN、MO组 (P <0 0 5 )及对照组 (P <0 0 1) ;MO组水平相当于EN组 (P >0 0 5 ) ,EN及MO组高于对照组 (P <0 0 5 ) ;CRP水平 :与对照组比较 ,MO组最高 ,PN组明显高于EN和对照组 (P <0 0 1) ,低于MO组 (P <0 0 5 )。EN、PN组明显低于MO组 (P <0 0 1)。　结论 :　EN、PN在有效提高机体营养状态的同时 ,EN能有效地维护胃肠道粘膜免疫功能 ,防止感染的发生 ;MO及PN明显降低胃肠道的免疫屏障功能 ,从而增加全身感染的可能性     

Lipid metabolism by the intestinal mucosa in malnourished subjects following enteral nutrition supplemented with omega3 fatty acids

Chronic malnutrition results in severe metabolic imbalance in man as the body modifies its modes of regulation of different nutrients, and in particular lipids. This study of the modifications in lipid metabolism induced by 15 days of enteral renutrition include: 12 malnourished patients (global nutritional deficit (GND) <20%) were given a cyclical enteral diet for 15 days under two conditions: ternary diet (Sondalis) or a similar diet whose lipid concentration was enriched by 5.3 g omega3 fatty acid per day. On Day 0 and Day 15, the serum lipid values were assayed and duodenal biopsies were taken to measure HMG-CoA reductase and (14)C acetate incorporation in the various classes of lipids. After 15 days of refeeding, the GND had been corrected by an average of 27% and HMG-CoA reductase activity had increased by 37% (60.2 +/- 7.46 vs 82.88 +/- 14.8 pmol/min/mg protein; p < 0.05). In 7 12 patients, the serum cholesterol values had increased (p < 0.01). No difference was observed in synthesis of FA, DG or cholesterol. Synthesis of phosphatidylcholines (PC) and phosphatidylglycerols (PG) was reduced by 12% and 23% respectively. Triglyceride synthesis (TG) increased by 20% (p < 0.05). The only difference between the two diets was in TG synthesis in organ-specific culture, which was increased only by the standard diet. In conclusion: (i) refeeding is accompanied by an increase in intestinal HMG-CoA reductase activity, a decrease in PC and PG synthesis, and an increase in TG synthesis; (ii) a diet enriched in omega3 FA increases TG synthesis less than the standard diet.     

围手术期应用肠内营养及抗生素对食管癌患者术后肠道菌群的影响

目的 通过测定食管癌术后患者部分肠道菌群的数量,反映不同抗生素及肠内、肠外营养应用方案对肠道菌群平衡的影响.方法 采用随机数字表法将60例食管癌患者随机分成6组,每组患者在围手术期分别接受6种不同的抗生素及肠内外营养干预方案:抗生素应用3d+术前、术后肠内营养(B组);抗生素应用3d+术前肠外营养、术后肠内营养(C组);抗生素应用3d+术前、术后肠外营养(D组);抗生素应用7d+术前、术后肠内营养(E组);抗生素应用7d+术前肠外营养、术后肠内营养(F组);抗生素应用7d+术前、术后肠外营养(G组).采用光冈菌群测定法检测患者术后第1次粪便中拟杆菌、双歧杆菌、乳酸杆菌、肠杆菌及肠球菌数量.以健康成年人作为对照组,比较各组菌群数量及双歧杆菌与肠杆菌比值(B/E值)的差异,并观察术后1个月内患者的并发症发生率.结果 B组双歧杆菌[(10.59±0.39)比(10.88±0.10) lg10n/ml,P=0.186]、乳酸杆菌[(8.59±0.31)比(8.72±0.22) lg10n/ml,P=0.534]、肠杆菌[(8.43±0.50)比(8.67 ±0.24) lg10n/ml,P=0.266]、肠球菌[(7.40±0.61)比(7.78±0.16) lg10n/ml,P=0.111]及B/E值[(1.2589±0.0644)比(1.2560±0.0330),P=0.825]与对照组的差异均无统计学意义.C、D、E、F、G组的拟杆菌[(11.08±0.48),P=0.139; (9.23±0.42),P=0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000;(8.05±0.53),P=0.000比(11.36±0.48) lg10n/ml]、双歧杆菌[(10.19±0.49),P=0.062; (9.00±0.52),P=0.000; (9.31±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99±0.56),P=0.000比(10.59±0.39) lg10n/ml]、乳酸杆菌[(7.99±0.58),P=0.006; (6.84±0.47),P=0.000; (7.72±0.35),P=0.000; (6.93±0.43),P=0.000; (5.93±0.76),P=0.000比(8.59±0.31) lg10n/ml]、肠杆菌[(8.19 ±0.43),P=0.258;(7.93±0.60),P=0.020;(7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P=0.000比(8.43±0.50) lg10n/ml]、肠球菌[(6.90±0.54),P=0.037;(5.89±0.68),P=0.000;(6.20±0.52),P=0.000;(5.91±0.39),P=0.000;(5.14±0.58),P=0.000比(7.40±0.61) lg10n/ml]数量较B组均减少.D及G组B/E值较对照组显著降低(1.1433±0.1350,P=0.025; 1.0706±0.1413,P=0.000比1.2560±0.0330).各组肺部感染(x2=3.647,P=0.601)及吻合口瘘发生率(x2=5.000,P=0.416)的差异均无统计学意义.结论 术前3d及术后积极应用肠内营养有益于肠道微生态平衡;术后长时间应用抗生素易造成菌群失调.