大黄辅助早期肠内营养对急性坏死性胰腺炎病程影响的研究

目的 探讨联合应用早期肠内营养(EEN)与大黄对大鼠急性坏死性胰腺炎(ANP)的影响.方法 48只Wistar大鼠随机分为4组(n=12):ANP组(A)、大黄组(B)、EEN组(C)及EEN联合大黄组(D).B、C、D组分别于造模后经肠内营养管输入大黄、肠内营养液及肠内营养液联合大黄.各组于造模48 h后测定血肿瘤坏死因子(TNF-α)、内毒素、D-乳酸、丙二醛(MDA)、血管紧张素Ⅱ(AngⅡ)、肠道分泌型免疫球蛋白A(SIgA)水平、腹水量及回肠湿干重比;检测胰腺髓过氧化物酶(MPO)活性及湿干重比,对胰腺组织进行病理学评分.结果 与A组相比.B、C、D组各项指标均有显著差异(P<0.05);与B、C组相比,D组除肠道SIgA显著升高外,其余指标均显著降低(P<0.05).结论 ANP时,联合应用EEN与大黄可有效保护肠道屏障功能、增强机体免疫力、抑制系统炎症反应、改善微循环障碍;联合治疗优于单一治疗.

An experimental study of effect of rhubarb assisted early enteral nutrition on acute necrotizing pancreatitis

Objective To investigate the effect of rhubarb assisted early enteral nutrition (EEN) on acute necrotizing pancreatitis(ANP) in rats. Methods A total of 48 Wistar rats were ran-domized into 4 groups(n=12) including ANP group (group A), rhubarb group (group B), EEN group (group C) and rhubarb assisted EEN (RAEEN) group (group D). The rats in group B, C and D were infused with rhubarb, enteral nutrient solution and enteral nutrient solution plus rhubarb by enteral nutrient canal after establishing the model, respectively. The remaining living animals in each group were sacrificed 48 hours after ANP models were developed to determine the tumor necrosis fac-tor-alpha (TNF-α), endotoxin, D-lactate, maleic dialdehyde (MDA), angiotensin Ⅱ (Ang Ⅱ) in ser-um. The intestinal secretory IgA (SIgA), the amount of ascitic fluid and the wet-dry weight ratio of ileum, the pancreatic Myeloperoxidase (MPO) activity as well as the wet-dry weight ratio of pancreas were determined and the pathologic changes of pancreas were analyzed by histopathologic grading and scoring of the severity of pancreas. Results Compared with group A, group B, C and D had signifi-cant difference in every index (P<0. 05). Furthermore, compared with rhubarb and EEN, RAEEN significantly increased the level of intestinal SIgA but reduced the other data obviously (P<0. 05). Conclusion Administration of RAEEN can effectively protect the intestinal barrier function, improve the organismic immunity, inhibit the systemic inflammatory reaction and ameliorate the microcirculato-ry disorders in ANP. The combined strategy is more safe and effective than either one alone.