手术创伤后患者的肠道通透性以及肠内营养与肠外营养的效果
Intestinal permeability in patients after surgical trauma and effect of enteral nutrition versus parenteral nutrition.
作者信息
Jiang Xiao-Hua, Li Ning, Li Jie-Shou
机构信息
Research Institute of General Surgery, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China.
出版信息
World J Gastroenterol. 2003 Aug;9(8):1878-80. doi: 10.3748/wjg.v9.i8.1878.
AIM
To study the intestinal permeability (IP) following stress of abdominal operation and the different effects on IP of enteral nutrition (EN) and parenteral nutrition (PN).
METHODS
Forty patients undergoing abdominal surgery were randomized into 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-1), POD 7 and POD 12, 10 g of lactulose and 5 g of mannitol were given orally, and urine was collected for 6 hours. Urine excretion ratios of lactulose and mannitol (L/M) were measured.
RESULTS
L/M ratios of EN group on POD-1, POD 7 and POD 12 were 0.026+/-0.017, 0.059+/-0.026, 0.027+/-0.017, respectively, and those of PN group were 0.025+/-0.013, 0.080+/-0.032, 0.047+/-0.021, respectively. Patients of both groups had elevated L/M ratios on POD 7 vs. POD-1. However the ratio returned toward control level in EN group by POD 12. In contrast, PN group still had elevated L/M ratios on POD 12.
CONCLUSION
L/M ratio increases for a period of time after surgical trauma and the loss of gut mucosal integrity can be reversed by substitution of enteral nutrition.
目的
研究腹部手术后应激状态下的肠道通透性（IP）以及肠内营养（EN）和肠外营养（PN）对IP的不同影响。
方法
40例接受腹部手术的患者被随机分为EN组和PN组。每组从术后第3天至第11天接受相同氮量和热量的营养支持。在手术前一天（术后第-1天）、术后第7天和第12天，口服给予10 g乳果糖和5 g甘露醇，并收集6小时尿液。测量乳果糖和甘露醇的尿排泄率（L/M）。
结果
EN组在术后第-1天、第7天和第12天的L/M比率分别为0.026±0.017、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。两组患者术后第7天的L/M比率均高于术后第-1天。然而，EN组在术后第12天时该比率恢复至对照水平。相比之下，PN组在术后第12天时L/M比率仍升高。
结论
手术创伤后一段时间内L/M比率升高，通过肠内营养替代可逆转肠黏膜完整性的丧失。
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