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目的研究肠道缺血再灌注损伤时肠淋巴干结扎和含谷氨酰胺的肠内营养对肠道及远隔组织的影响。方法 40只SD大鼠胃造瘘后随机分为:假手术组、普通肠内营养组、普通肠内营养+肠淋巴干结扎组、谷氨酰胺组及谷氨酰胺+肠淋巴干结扎组,每组8只。除假手术组外,其余4组大鼠行7 d肠内营养干预后开腹夹闭肠系膜上动脉60 min,2个结扎组同时进行淋巴干结扎;假手术组行普通饮食7 d后开腹60 min后关腹。所有大鼠术后继续原营养3 d。于再灌注前1 d、再灌注后1 d及3 d测定肠道通透性,在再灌注后3 d观察肠壁形态学改变,检测血清中内毒素、D-乳酸、二胺氧化酶水平及肺组织细胞凋亡指数。结果再灌注后1 d时,各组肠道通透性均比再灌注前明显增加(P<0.05);再灌注后3 d时与再灌注后1 d比较,2个结扎组的肠道通透性均明显降低(P<0.05)。谷氨酰胺+肠淋巴干结扎组回肠和空肠的黏膜厚度及回肠的绒毛高度明显高于其余4组(P<0.05),谷氨酰胺组回肠的绒毛高度明显高于普通肠内营养组(P<0.05);普通肠内营养+肠淋巴干结扎组肠壁各形态学指标均高于普通肠内营养组,但差异无统计学意义(P>0.05)。肠淋巴干结扎组的肺组织细胞凋亡指数明显低于未结扎组(P<0.05),内毒素、D-乳酸及二胺氧化酶水平较未结扎组有下降趋势,但差异无统计学意义(P>0.05)。结论大鼠肠道缺血再灌注损伤引起肠道通透性增加、细菌内毒素移位和系统炎症反应,肠淋巴管结扎和谷氨酰胺肠内营养干预可以弱化肺组织损伤,增加肠黏膜的厚度,维护肠屏障功能,减少内毒素移位,降低血中内毒素水平,减轻系统炎症反应。含谷氨酰胺的肠内营养效果优于普通肠内营养。
Objective To study the effect of intestinal lymph node ligation and glutamine-containing enteral nutrition on intestinal tract and distant tissue during intestinal ischemia-reperfusion injury. Methods Forty SD rats were randomly divided into four groups: sham-operated group, normal enteral nutrition group, common enteral nutrition + intestinal lymph node ligation group, glutamine group and glutamine + intestinal lymph node ligation group, Each group of 8. Except for the sham operation group, the rats in the other four groups received laparotomy for 60 min after intervention of intestinal enteral nutrition for 7 d, and the two ligation groups were simultaneously subjected to lymphatic ligation. Sham-operation group were given laparotomy Close the abdomen after 60 min. All rats continued to the original nutrition 3 d after surgery. The intestinal permeability was measured 1 d before reperfusion and 1 d and 3 d after reperfusion. The morphological changes of intestinal wall were observed 3 d after reperfusion. The levels of endotoxin, D-lactate and diamine oxidase And lung cell apoptosis index. Results At 1 d after reperfusion, the intestinal permeability of each group was significantly higher than that before reperfusion (P <0.05). At 3 d after reperfusion, compared with 1 d after reperfusion, Permeability were significantly reduced (P <0.05). The mucosal thickness of ileum and jejunum and villus height of ileum in glutamine + intestinal lymph node ligation group were significantly higher than those in the other 4 groups (P <0.05). The ileum height in glutamine group was significantly higher than that in normal enteral nutrition group (P <0.05). The morphological indexes in the common enteral nutrition + intestinal lymph node ligation group were higher than those in the normal enteral nutrition group, but the difference was not statistically significant (P> 0.05). The apoptotic index of lung tissue in intestinal lymph node ligation group was significantly lower than that in non-ligation group (P <0.05), and the levels of endotoxin, D-lactate and diamine oxidase decreased compared with those in non-ligation group, but the difference was not statistically significant (P> 0.05). Conclusion Intestinal ischemia-reperfusion injury in rats leads to increased intestinal permeability, bacterial endotoxin translocation and systemic inflammatory response, intestinal lymphatic vessel ligation and glutamine enteral nutrition can weaken lung tissue injury, increase intestinal mucosa Thickness, to maintain intestinal barrier function, reduce endotoxin translocation, reduce blood endotoxin levels and reduce systemic inflammatory response. Enteral nutrition with glutamine is better than ordinary enteral nutrition.