Fukatsu Kazuhiko, Ueno Chikara, Maeshima Yoshinori, Mochizuki Hidetaka, Saitoh Daizoh
Division of Traumatology, National Defense Medical College Research Institute, Saitama, Japan.
J Surg Res. 2008 Sep;149(1):31-8. doi: 10.1016/j.jss.2007.12.749. Epub 2008 Jan 10.
Although early enteral nutrition after insult has many advantages, effects of early nutritional manipulation on outcome after gut ischemia-reperfusion (I/R) remain unclear. We hypothesize that early enteral nutrition would improve survival after severe gut I/R by reducing organ injury and leukocyte activation.
Mice were randomized to chow, intravenous (IV)-total parenteral nutrition (TPN), intragastric (IG)-TPN, or complex enteral diet (CED) for feeding after I/R. In experiment 1, 72 mice underwent both IV cannulation and gastrostomy before 45 or 10 min gut ischemia. At 12 (45 and 10 min ischemia) or 24 h (45 min ischemia) after I/R, mice were given one of the above diets. The chow group received IV saline and free access to chow was started at 12 or 24 h after I/R, i.e., no infusion of nutritional solutions. Survival was observed until 120 h. In experiment 2, 25 mice received one of the above diets at 12 h after 45 min gut I/R. Organ vascular permeability was assessed with Evans blue at 6 h after feeding. Reactive oxygen intermediate production with or without phorbol myristate acetate stimulation by circulating myeloid cells and expressions of CD11a and CD11b on these cells were also determined using flow cytometry.
When feeding started at 12 h after 45 min ischemia, IV-TPN, IG-TPN, and CED significantly reduced survival time, as compared with chow. However, no significant difference was observed when feeding started at 24 h. There were no significant differences in survival times after 10 min ischemia among the four groups. Lung and small intestine vascular permeability was significantly higher in the IV-TPN group than in the other groups. There were no significant differences in reactive oxygen intermediate production or adhesion molecule expressions.
Early nutrition administration after severe I/R reduces survival, possibly by increasing organ injury in IV-TPN and by other mechanisms in IG-TPN and CED.
尽管损伤后早期肠内营养有诸多益处，但早期营养干预对肠道缺血再灌注（I/R）后结局的影响仍不明确。我们推测早期肠内营养可通过减轻器官损伤和白细胞激活来改善严重肠道I/R后的生存率。
将小鼠随机分为正常饮食组、静脉（IV）-全胃肠外营养（TPN）组、胃内（IG）-TPN组或复合肠内饮食（CED）组，在I/R后进行喂养。在实验1中，72只小鼠在肠道缺血45或10分钟前进行静脉插管和胃造口术。在I/R后12小时（45和10分钟缺血）或24小时（45分钟缺血），给小鼠喂食上述饮食之一。正常饮食组接受静脉生理盐水，在I/R后12或24小时开始自由进食普通食物，即不输注营养溶液。观察生存率至120小时。在实验2中，25只小鼠在肠道45分钟I/R后12小时接受上述饮食之一。喂食后6小时用伊文思蓝评估器官血管通透性。还使用流式细胞术测定循环髓样细胞在有或无佛波酯肉豆蔻酸酯乙酸盐刺激下的活性氧中间体产生以及这些细胞上CD11a和CD11b的表达。
在45分钟缺血后12小时开始喂食时，与正常饮食组相比，IV-TPN组、IG-TPN组和CED组显著缩短了生存时间。然而，在24小时开始喂食时未观察到显著差异。在10分钟缺血后，四组之间的生存时间无显著差异。IV-TPN组的肺和小肠血管通透性显著高于其他组。活性氧中间体产生或黏附分子表达无显著差异。
严重I/R后早期给予营养会降低生存率，可能是通过增加IV-TPN组的器官损伤以及IG-TPN组和CED组的其他机制。
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