Chuang J H, Chen W J, Lo S K, Chang N K
Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
JPEN J Parenter Enteral Nutr. 1997 Jan-Feb;21(1):36-40. doi: 10.1177/014860719702100136.
Inadequate oral intake and poor absorption result in malnutrition in obstructive jaundice. Both malnutrition and obstructive jaundice promote bacterial translocation from the gut. This study was designed to test the efficacy of tube feeding in preventing malnutrition and in decreasing the metabolic and microbiological adverse effects in obstructive jaundice.
Forty adult mongrel dogs were studied and were allocated into one of four groups: group I (PO-control) underwent sham ligation of the common bile duct (CBDL) and was fed ad libitum on Portagen (Mead Johnson, Evansville, IN); group II (PO-CBDL) underwent CBDL and was ad libitum fed on the same formula; group III (FEG-control) underwent sham CBDL and received forced esophagogastric feeding (FEG) with Portagen; and group IV (FEG-CBDL) underwent CBDL and received FEG. All the animals underwent insertion of a F-12 feeding tube to the stomach from an esophagotomy wound on day 1 and the tube was used for continuous enteral feeding with Portagen over 4 h/d from day 2 until day 13 in groups III and IV. Fourteen days later, blood samplings were done and a laparotomy was performed to obtain liver, mesenteric lymph nodes (MLN), and terminal ileum for quantitative bacterial culture. Bacterial translocation to MLN and liver was represented by log10 CFU/g of tissue in this study.
Both group II and IV animals with CBDL significantly lost body weight (p = .0001) and had a lower level of prealbumin (p = .0054). A significant increase in bacterial translocation to MLN and to liver occurred in groups II and IV (p = .0017 and .0268, respectively). Intestinal bacterial population was also higher in these two groups than in the other two controls (p = 0.0028). An increase in plasma ammonia level was found in dogs with CBDL (p = .0002) and in dogs with FEG (p = .003), compared with their respective controls. Three among 13 dogs in group IV died and no mortality occurred in the other groups (p = .223).
Tube feeding fails to improve malnutrition in obstructive jaundice and is associated with intestinal bacterial overgrowth, promoting bacterial translocation to MLN and liver, precipitating liver dysfunction and consequently a higher mortality.
经口摄入不足和吸收不良导致梗阻性黄疸患者营养不良。营养不良和梗阻性黄疸均会促进肠道细菌易位。本研究旨在测试管饲法在预防梗阻性黄疸患者营养不良以及降低其代谢和微生物学不良影响方面的疗效。
对40只成年杂种犬进行研究，并将其分为四组之一：第一组（经口喂养-对照）接受胆总管假结扎术（CBDL），并随意喂食葆婴佳膳（美赞臣公司，印第安纳州埃文斯维尔）；第二组（经口喂养-CBDL）接受CBDL，并以相同配方随意喂食；第三组（强制食管胃喂养-对照）接受假CBDL，并通过强制食管胃喂养（FEG）给予葆婴佳膳；第四组（强制食管胃喂养-CBDL）接受CBDL并接受FEG。所有动物在第1天从食管切开术伤口插入一根F-12饲管至胃内，在第三组和第四组中，从第2天至第13天，该饲管用于每天4小时持续肠内给予葆婴佳膳。14天后，采集血样并进行剖腹手术，获取肝脏、肠系膜淋巴结（MLN）和回肠末端进行定量细菌培养。在本研究中，细菌易位至MLN和肝脏以每克组织中log10 CFU表示。
第二组和第四组接受CBDL的动物体重均显著下降（p = 0.0001），前白蛋白水平较低（p = 0.0054）。第二组和第四组中细菌易位至MLN和肝脏的情况显著增加（分别为p = 0.0017和0.0268）。这两组的肠道细菌数量也高于其他两个对照组（p = 0.0028）。与各自的对照组相比，接受CBDL的犬（p = 0.0002）和接受FEG的犬（p = 0.003）血浆氨水平升高。第四组13只犬中有3只死亡，其他组未发生死亡（p = 0.223）。
管饲法未能改善梗阻性黄疸患者的营养不良，且与肠道细菌过度生长有关，促进细菌易位至MLN和肝脏，引发肝功能障碍，进而导致更高的死亡率。
