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目的:探讨营养支持途径对严重烧伤早期肠黏膜修复的影响.方法:将30%TBSAⅢ度烧伤大鼠行颈外静脉插管后,随机分为肠道喂养(EF)组及静脉营养(PN)组,分别采用灌喂和颈外静脉输入方法给予等氮、等热卡的营养液.动态观察空肠与回肠黏膜组织形态学的变化,用图像分析仪测量肠黏膜厚度、绒毛高度,并计算绒毛表面积.结果:烧伤后早期PN组与EF组的空肠与回肠黏膜组织结构均受到明显损害.EF组伤后6,12,24,48h空肠和回肠黏膜厚度分别为341±33μm、404±30μm、418±42μm、418±57μm及313±34μm、306±81μm、302±55μm、268±21μm,绒毛高度分别为253±33μm、287±23μm、285±42μm、260±40μm及175±30μm、210±57μm、190±31μm、163±17μm,绒毛表面积分别为0.045±0.011mm2、0.056±0.011mm2、0.071±0.007mm2、0.054±0.006mm2及0.030±0.006mm2、0.045±0.019mm2、0.036±0.011mm2、0.028±0.004mm2,均与PN组无明显差别(P>0.05).但至伤后72h,EF组空肠和回肠黏膜厚度、绒毛高度及绒毛表面积分别为397±34μm、253±41μm、0.051±0.009mm2及275±38μm、180±31μm、0.030±0.006mm2,而PN组空肠和回肠黏膜厚度、绒毛高度及绒毛表面积分别为227±25μm、146±14μm、0.024±0.0062mm2及206±15μm、125±16μm、0.017±0.0042mm2,EF组非常明显地高于PN组(P<0.01).结论:肠道喂养较静脉营养能更好地维护严重烧伤后早期肠黏膜组织结构,促进受损肠黏膜的修复.
Objective: To investigate the effect of nutritional support on the early repair of severe intestinal mucosa in burn patients.Methods: 30% TBSA Ⅲ degree burned rats were randomly divided into four groups: enteral feeding (EF) and intravenous nutrition (PN) The rats were randomly divided into 4 groups: control group, nourishment group and control group. The nutrition solution of equal nitrogen and heat card was given by feeding and external jugular vein respectively. Dynamic observation of histomorphology of jejunum and ileum mucosa, thickness of intestinal mucosa and villus height with image analyzer, Surface area.Results: The jejunum and ileal mucosa tissue structure of PN group and EF group were significantly impaired in the early postburn group.The thickness of jejunum and ileum mucosa at 6, 12, 24 and 48 hours after injury in EF group were 341 ± 33μm and 404 ± 30μm, 418 ± 42μm, 418 ± 57μm and 313 ± 34μm, 306 ± 81μm, 302 ± 55μm and 268 ± 21μm, villus height were 253 ± 33μm, 287 ± 23μm, 285 ± 42μm, 260 ± 40μm and 175 ± 30μm, 210 ± 57μm, 190 ± 31μm and 163 ± 17μm. The surface area of villus was 0.045 ± 0.011mm2, 0.056 ± 0.011mm2, 0.071 ± 0.007mm2, 0.054 ± 0.006mm2, 0.030 ± 0.006mm2, 0.045 ± 0.019mm2, 0.036 ± 0.011mm2, 0.028 ± 0.004mm2, no significant difference with the PN group (P> 0.05), but to the injury At 72h, the thickness of jejunum and ileum, the height of villus and the surface area of villus in EF group were 397 ± 34μm, 253 ± 41μm, 0.051 ± 0.009mm2 and 275 ± 38μm, 180 ± 31μm and 0.030 ± 0.006mm2 respectively, while the jejunum and ileal mucosa The thickness, villus height and villus surface area were 227 ± 25μm, 146 ± 14μm, 0.024 ± 0.0062mm2 and 206 ± 15μm, 125 ± 16μm and 0.017 ± 0.0042mm2, respectively, and EF group was significantly higher than PN group (P <0.01). CONCLUSIONS: Enteral feeding compared with intravenous nutrition can better maintain the early intestinal mucosa tissue structure after severe burns and promote the repair of damaged intestinal mucosa.