手术创伤应激下肠黏膜通透性的改变及肠内肠外营养作用的比较

目的研究手术创伤对肠黏膜通透性的影响,并研究肠内和肠外营养对肠黏膜通透性的不同作用.方法 40例腹部手术的患者随机分为肠内营养(EN)组和肠外营养(PN)组,分别于术后3～11d予等氮、等热卡营养支持,并分别于术前1 d、术后7 d和术后12 d,测定口服含乳果糖10 g、甘露醇5 g的测试液后6 h尿中乳果糖和甘露醇排泄率的比值(L/M)变化,用高压液相色谱法测定尿中乳果糖和甘露醇的浓度.结果术前、术后7 d和术后12 d L/M比值EN组分别为0.026±0.01 7、0 059±0.026、0 027±0 017;PN组分别为0 025±0 013、0 080±0.032、0 047±0.021.术后7 d两组L/M比值较术前均显著升高,且PN组明显高于EN组;术后12 d L/M比值PN组仍明显高于术前及EN组,而EN组与术前无明显差异.结论创伤应激早期肠黏膜通透会有明显升高,在创伤的早期需注意维护肠黏膜屏障功能;肠内营养有较好的维护肠黏膜屏障功能的作用.

Change of permeability and comparison of effects between enteral and parental nutrition on intestinal permeability in patients after abdominal operation

Objective To examine the intestinal permeability(IP) after abdominal operation and compare the different effects between enteral nutrition(EN) and parental nutrition(PN)on IP.Methods Forty patients undergone abdominal surgery were randomly divided into two groups: EN group and PN group. Each group received nutritional support of the same nitrogen and calorie from postoperative day (POD)3 to POD 11. On the day before operation, POD 7 and POD 12, 10 g of lactulose and 5 g of mannitol were given, and 6 hour urine after administration was collected for detecting lactulose/mannitol(L/M) ratio. Results Elevated lactulose/mannitol (L/M) ratios were found in all the patients at POD 7 as compared to POD 1. The elevated ratio returned to control level in EN group by day 12, but still remained high in PN group patients at POD 12. Conclusions L/M ratio increases in the early period after surgical trauma. EN can provide a better protection against IP.