Shao H, Yao Z Y, Wang S L
Center of Surgery, Chengdu General Hospital, Chengdu Unit of Peoples's Liberation Army.
Zhonghua Wai Ke Za Zhi. 1994 Jul;32(7):438-42.
In order to approach the mechanism of hypermetabolic response following severe burn injury, a new animal model was developed with a specially bred miniswine (Guizhou species). Multiple catheterizations were applied for sampling different blood from portal, inferior mesenteric as will as jugular (central) veins. The animals were sustained with 30% III burn of TB-SA and divided randomly into early feeding group, given a complete diet beginning from 2 hours postburn (N = 6), and delayed feeding group, given the same diet initiating on 4 day postburn (N = 6). The results showed that compared with delayed feeding, early enteral feeding could strengthen the barrier function, decline the rate of translocation of bacteria and endotoxin from the gut to portal vein, reduce obviously blood TNF, CRP and catabolic-hormones, and significantly decrease REE (resting energy expenditure) and urinary 3-Mehis excretion. During the hypermetabolism (PBD7-10), the metabolic response mediated by "intestinal way" was at least 35%. The way of "intestinal tract--macrophages in liver--Hypermetabolism" is a possible mechanism of hypermetabolic response following severe burn injury, and the bacteria and endotoxin translocated from the gut, the active products (IL-1, TNF, etc) released by Kupffer's cells might be the mediating factors of the mechanism.
为探讨严重烧伤后高代谢反应的机制,采用特殊培育的贵州小型猪建立了一种新的动物模型。通过多次插管从门静脉、肠系膜下静脉以及颈静脉(中心静脉)采集不同的血液样本。对动物造成30%体表面积的Ⅲ度烧伤,并随机分为早期喂养组(烧伤后2小时开始给予全价日粮,N = 6)和延迟喂养组(烧伤后第4天开始给予相同日粮,N = 6)。结果显示,与延迟喂养相比,早期肠内喂养可增强屏障功能,降低细菌和内毒素从肠道向门静脉的移位率,明显降低血液中TNF、CRP和分解代谢激素水平,并显著降低静息能量消耗(REE)和尿3 - 甲基组氨酸排泄量。在高代谢期(伤后第7 - 10天),“肠道途径”介导的代谢反应至少占35%。“肠道 - 肝脏巨噬细胞 - 高代谢”途径可能是严重烧伤后高代谢反应的机制之一,肠道移位的细菌和内毒素、库普弗细胞释放的活性产物(IL - 1、TNF等)可能是该机制的介导因素。