胃肠道手术后早期肠内营养对肠通透性的影响

目的：观察早期肠内营养（EEN）对胃肠道手术后肠屏障功能的影响。方法：采用前瞻、随机、双盲对照方法,选取60例胃肠道大手术患者,其中30例术后第3～5天起应用肠内营养（EN）粉剂作实验组,另外30例术后第3天起2周内应用全肠外营养（TPN）作为对照组。两组患者分别予以等氮、等热卡营养支持。术后3d、7d和14d分别给予肠通透性测试液（内含乳果糖2g,甘露醇1g）,留取6h尿液,并且于手术前1d、手术后4d和8d晨分别抽取血。采用液相色谱串联质谱法测定尿中乳果糖（L）和甘露醇（M）的浓度,用MB-80微生物动态检测系统和EKT-5Mset试剂盒检测两组患者血浆内毒素水平。结果：（1）肠通透性（L/M）对比：术后8d两组L/M比值较术后3d均升高,对照组明显高于实验组,但无显著性差异;术后14dL/M比值对照组明显高于实验组,两组有显著性差异（P〈0.01）,对照组术后3d和8d之间有明显差异（P〈0.05）。（2）血浆内毒素水平：术后4d较术前1d两组血浆内毒素均有所升高,但无显著性差别;术后7d对照组血浆内毒素呈逐渐升高趋势,实验组血浆内毒素呈逐渐下降趋势,两组间对比有显著性差别（P〈0.01）。结论：创伤应激早期肠粘膜通透会有明显升高,肠内营养有较好维护肠粘膜屏障功能的作用,早期EN有助于维持肠屏障结构和功能,纠正肠道菌群失调,从而降低内毒素血症。

Effects of Gastrointestinal Postoperative Early Enteral Nutrition on the Intestinal Barrier Function

Objective:To observe the effect of early enteral nutrition (EEN) on intestinal barrier function after the gastrointestinal surgery. Methods: Using of prospective, randomized, double-blind and controlled method, sixty patients received gastrointestinal operations were randomly divided into two groups (30 for each). The experimental group received enteral nutrition 3-5 days after the operation and the control group received total parenteral nutrition(TPN) 3 days after the operation. The patients were administ...