Kiyama T, Witte M B, Thornton F J, Barbul A
Department of Surgery, Sinai Hospital of Baltimore, the Johns Hopkins Medical School, Maryland 21215, USA.
JPEN J Parenter Enteral Nutr. 1998 Sep-Oct;22(5):276-9. doi: 10.1177/0148607198022005276.
Nutrition support via the enteral route has been shown to be superior to parenteral administration in maintaining immune function, decreasing septic complications, and increasing survival after severe trauma and surgical injury. Whether the route of nutrition support affects wound healing, another important determinant of outcome following injury, is not known.
Forty-nine Sprague-Dawley rats, 290 to 360 g body wt, underwent identical surgical manipulation consisting of central venous catheterization, fashioning of gastrostomy and dorsal skin incision, and placement of polyvinyl alcohol sponges into subcutaneous pockets. Identical infusates of 25% dextrose, 4.25% amino acids, and vitamins were given, half the animals receiving the infusion via the gastrostomy and the other half via the venous catheter. Animals were killed on day 5, 7, or 10. Wound breaking strength, sponge hydroxyproline content (an index of wound collagen deposition), and types I and III collagen gene expression were measured.
There were no nutritional differences between the two groups in terms of energy intake, body weight gain, and plasma levels of albumin, total protein, or urea nitrogen. On day 5 wound breaking strength was significantly higher in the enterally supported group (89.3 +/- 90.7 vs 64.9 +/- 40.2 g for the parenteral group, p < .05). This was paralleled by enhanced wound collagen accumulation (182 +/- 19 vs 132 +/- 13 microg, p < .05). Gene expression of type I, but not type III, collagen also was increased in the enterally fed group. There were no differences noted between the two groups in wound healing parameters 7 and 10 days after injury.
The data demonstrate that the route of nutrition administration can influence wound healing. The beneficial effect of the enteral feeding route is limited to the early phases of healing.
在严重创伤和外科手术后，经肠内途径给予营养支持在维持免疫功能、减少脓毒症并发症及提高生存率方面已被证明优于肠外营养支持。营养支持途径是否会影响伤口愈合（这是损伤后另一个重要的预后决定因素）尚不清楚。
49只体重290至360克的Sprague-Dawley大鼠接受相同的外科手术操作，包括中心静脉置管、胃造口术和背部皮肤切口，并将聚乙烯醇海绵放入皮下袋中。给予相同的25%葡萄糖、4.25%氨基酸和维生素输注液，一半动物通过胃造口术输注，另一半通过静脉导管输注。在第5、7或10天处死动物。测量伤口断裂强度、海绵羟脯氨酸含量（伤口胶原沉积的指标）以及I型和III型胶原基因表达。
两组在能量摄入、体重增加以及白蛋白、总蛋白或尿素氮的血浆水平方面没有营养差异。在第5天，肠内营养支持组的伤口断裂强度显著更高（肠外营养组为89.3±90.7克，肠内营养组为64.9±40.2克，p<.05）。同时伤口胶原积累也有所增加（182±19微克对132±13微克，p<.05）。肠内喂养组I型胶原的基因表达增加，但III型胶原没有。在损伤后7天和10天，两组的伤口愈合参数没有差异。
数据表明营养给药途径可影响伤口愈合。肠内喂养途径的有益作用仅限于愈合的早期阶段。
