Spaeth G, Berg R D, Specian R D, Deitch E A
Department of Surgery, Louisiana State University School of Medicine, Shreveport.
Surgery. 1990 Aug;108(2):240-6; discussion 246-7.
To determine whether the route and/or composition of nutritional support alters intestinal barrier function (measured as bacterial translocation), rats were divided into three groups: food (controls), intravenous total parenteral nutrition (IV-TPN) fed, and oral total parenteral nutrition (ORAL-TPN) fed. Bacterial translocation did not occur in the rats that were fed normally, but did occur in 60% of the rats fed the IV-TPN or the ORAL-TPN diets for 7 days (p less than 0.05). Since both the IV-TPN and ORAL-TPN diets induced bacterial translocation and the TPN solution (28% glucose and 4.5% amino acids) lacks fiber, two additional groups of rats were fed orally 2.5 gm cellulose powder/day plus TPN solution by either the intravenous or the oral route. The addition of cellulose powder decreased the incidence of bacterial translocation to 8% in the group fed the ORAL-TPN diet and to 0% in the group fed the IV-TPN diet. Cellulose improved intestinal barrier function, even though it did not prevent bacterial overgrowth or the loss of mucosal mass in the rats fed the IV-TPN or ORAL-TPN diets. Cellulose powder appears to have prevented bacterial translocation primarily by preventing IV-TPN- or ORAL-TPN-induced alterations in mucosal structure. Thus the oral administration of this fiber maintains intestinal barrier function and prevents bacterial translocation even in the absence of oral nutrients.
为了确定营养支持的途径和/或成分是否会改变肠道屏障功能(以细菌移位来衡量),将大鼠分为三组:食物喂养组(对照组)、静脉全胃肠外营养喂养组和口服全胃肠外营养喂养组。正常喂养的大鼠未发生细菌移位,但静脉全胃肠外营养或口服全胃肠外营养喂养7天的大鼠中有60%发生了细菌移位(p<0.05)。由于静脉全胃肠外营养和口服全胃肠外营养饮食均诱导细菌移位,且全胃肠外营养液(28%葡萄糖和4.5%氨基酸)缺乏纤维,另外两组大鼠通过静脉或口服途径每天口服2.5克纤维素粉末加全胃肠外营养液。添加纤维素粉末后,口服全胃肠外营养饮食组的细菌移位发生率降至8%,静脉全胃肠外营养饮食组降至0%。纤维素改善了肠道屏障功能,尽管它并不能防止静脉全胃肠外营养或口服全胃肠外营养饮食喂养的大鼠出现细菌过度生长或黏膜质量损失。纤维素粉末似乎主要通过防止静脉全胃肠外营养或口服全胃肠外营养诱导的黏膜结构改变来预防细菌移位。因此,即使在没有口服营养物质的情况下,口服这种纤维也能维持肠道屏障功能并防止细菌移位。