Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
Department of Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Marmara University, Istanbul, Turkey.
J Plast Reconstr Aesthet Surg. 2020 Mar;73(3):590-597. doi: 10.1016/j.bjps.2019.09.019. Epub 2019 Oct 4.
This study used an experimental model mimicking early postoperative enteral feeding after the transfer of free jejunal flap and tested the hypothesis that jejunal infusion with dextrose or saline is associated with improved tissue perfusion and/or less mucosal damage after ischemia/reperfusion (IR) injury.
Thirty-five male Sprague Dawley rats were randomly divided into five groups: sham group (no IR and no intraluminal infusion); IR control group (IR but not intraluminal infusion); IR plus intraluminal 0.9% NaCl infusion or 5% dextrose or 10% dextrose infusion groups. A jejunal segment of each rat was isolated. The animals had jejunal ischemia for 40 min, reperfusion, and intestinal infusion on the basis of their allocation. Jejunal tissue perfusion was measured with laser Doppler flowmetry at one hour and two hours after reperfusion, after which the animals were sacrificed and tissue samples were obtained for the scoring of histological damage at superficial and cryptic epithelium, villus structure, and inflammatory cell infiltration and tissue nitric oxide (NO), interleukin (IL)-1, IL-6, and matrix metalloproteinase-1 (MMP) level measurements.
At 1 h of reperfusion, IR plus 5% dextrose and 10% dextrose groups both had significantly higher perfusion rates than the IR control group (384.8 ± 26.7 and 462.4 ± 44.7 versus 270.3 ± 34.2 PU, respectively, p < 0.05 for both). These differences were maintained at 2 h of reperfusion (p < 0.05 for both). Saline infusion, however, resulted in improved tissue perfusion only at the early phase of reperfusion. Intraluminal infusion with dextrose solution, either 5% or 10%, was associated with higher tissue NO, IL-1, and IL-6 levels than that in the sham group (p < 0.05 for all). In addition, intraluminal infusion of any fluid resulted in less severe histological damage (8.1 ± 0.9 versus 5.8 ± 1.0, 5.4 ± 0.9, and 5.2 ± 1.9, for IR plus saline, 5% dextrose and 10% dextrose groups, respectively, p < 0.05 for all).
Intraluminal infusion of fluids, particularly dextrose solutions, may be protective against IR injury as demonstrated by improved tissue perfusion and less histological damage. In addition, increases in tissue NO, IL-1, and IL-6 levels in association with dextrose infusion may be explained by the activation of pro-inflammatory and anti-inflammatory protective pathways. These support early enteral feeding after free jejunum flap transfers; however, further studies are warranted.
本研究采用模拟游离空肠瓣转移后早期肠内喂养的实验模型，检验如下假设：空肠输注葡萄糖或生理盐水与缺血/再灌注（IR）损伤后组织灌注改善和/或黏膜损伤减轻有关。
35 只雄性 Sprague Dawley 大鼠随机分为 5 组：假手术组（无 IR 且无腔内输注）；IR 对照组（IR 但无腔内输注）；IR 加腔内 0.9%氯化钠输注或 5%葡萄糖或 10%葡萄糖输注组。每组大鼠均分离一段空肠。动物进行 40 分钟空肠缺血，然后根据分组进行再灌注和肠内输注。再灌注后 1 小时和 2 小时，使用激光多普勒血流仪测量空肠组织灌注，然后处死动物并获取组织样本，用于评估浅层和隐窝上皮、绒毛结构、炎症细胞浸润和组织一氧化氮（NO）、白细胞介素（IL）-1、IL-6 和基质金属蛋白酶-1（MMP）水平的组织学损伤评分。
再灌注 1 小时时，IR 加 5%葡萄糖和 10%葡萄糖组的灌注率均明显高于 IR 对照组（分别为 384.8±26.7 和 462.4±44.7 与 270.3±34.2 PU，均 p<0.05）。再灌注 2 小时时，这些差异仍然存在（均 p<0.05）。然而，生理盐水输注仅在再灌注早期阶段改善组织灌注。5%或 10%的葡萄糖溶液腔内输注与 sham 组相比，组织 NO、IL-1 和 IL-6 水平更高（均 p<0.05）。此外，任何液体的腔内输注均可减轻组织学损伤的严重程度（IR 加盐水、5%葡萄糖和 10%葡萄糖组分别为 8.1±0.9、5.4±0.9 和 5.2±1.9，均 p<0.05）。
液体腔内输注，特别是葡萄糖溶液，可能通过改善组织灌注和减轻组织学损伤来预防 IR 损伤。此外，与葡萄糖输注相关的组织 NO、IL-1 和 IL-6 水平升高可能与促炎和抗炎保护途径的激活有关。这些支持游离空肠瓣转移后早期肠内喂养，但需要进一步研究。
