| Objective:Through the clinical observation and animal experiments, observation surgical abdominal surgery gives early enteral nutrition and parenteral nutrition intestinal mucosa function after surgery for change, discusses the intestinal mucosa injury mechanism, evaluation early enteral nutrition for intestinal mucosa of protection.Methods:This paper is divided into clinical trials and animal experiment two parts, clinical trials are collecting large abdominal surgery patients, general stochastic give early enteral nutrition and completely parenteral nutrition, preoperative and postoperative patients collected a, four, sevendays in peripheral blood, inspection peripheral blood serum diamines oxidase (DAO) and malondialdehyde (MDA) and glutamine (Gin), observation postoperative early enteral nutrition and parenteral nutrition patients at different time points after intestinal mucosa function change, evaluation early enteral nutrition for surgical abdominal surgery patients intestinal mucosa function influence. Establish rat colon partial nephrectomy+enteral nutrition, and colon partial nephrectomy+parenteral nutrition animal models, and the establishment of normal control group. Animal model points time points, sterile conditions death take mesenteric lymph node do the bacteria cultures, observe the intestinal bacteria shift condition. Take the ileum and colon specimens, making pathological, observe the intestinal mucosa villi height, fossae depth, fluff surface area, mucous membrane thickness changes, immunohistochemical method between IgA+cells observation group in the number of bowel mucosa lamina propria changes, thus to evaluate its immune barrier function. Comparative rat early postoperative enteral nutrition and parenteral nutrition to the influence of intestinal mucosa function.Results:1. Abdominal surgery patients 1,4,7 days at the first postoperative serum DAO were improved significantly higher. (3.162±0.472 vs 1.421±0.453), (2.498±0.485 vs 1.421±0.453), (1.982±0.449vs 1.421±0.453) Difference was statistically significant. (P<0.01) First day after surgery, patients with early Enteral nutrition and parenteral nutrition in patients with no significant differences. (3.184±0.376vs 3.148±0.401),(P>0.05),.4 days and 7 days after surgery, enteral nutrition group was lower than the parenteral nutrition (2.028±0.314 vs3.135±0.387), (1.683±0.361 vs2.239±0.401) Difference was statistically significant. (P<0.01)2. Abdominal surgery patients 1,4,7 days at the first postoperative serum MDA were improved significantly higher. (2.223±0.415 vs1.142±0.321), (1.832±0.341 vs 1.142±0.321), (1.572±0.317vs 1.142±0.321) Difference was statistically significant. (P<0.01) First day after surgery, patients with early Enteral nutrition and parenteral nutrition in patients with no significant differences. (2.235±0.407 vs2.221±0.395),(P>0.05),.4 days and 7 days after surgery, enteral nutrition group was lower than the parenteral nutrition (1.532±0.326vs2.103±0.331),(1.395±0.298 vs 1.827±0.298)Difference was statistically significant. (P<0.01)3. Abdominal surgery patients 1,4,7 days at the first postoperative serum Glu were lessened significantly lower. (1.174±0.418 vs 1.965±0.403), (1.493±0.387 vs 1.965±0.403), (1.672±0.378vs 1.965±0.403), Difference was statistically significant. (P<0.01) First day after surgery, patients with early Enteral nutrition and parenteral nutrition in patients with no significant differences. (1.180±0.386 vs1.169±0.391),(P>0.05),.4 days and 7 days after surgery, enteral nutrition group was higher than the parenteral nutrition (1.598±0.376 vs 1.318±0.389),(1.788±0.346 vs 1.502±0.342)Difference was statistically significant. (P<0.01)4. The DAO, MDA and Gln in the plasma of patients were analyzed for correlation, respectively. Gln were negatively correlated with DAO and MDA (P<0.05), while DAO and MDA are positively correlated(P<0.05).These differences have statistical significance..5. The intestinal thickness, villous height, crypt depth and villous surface area of rats were lower after operation compared to the control group, however, that in the early enteral nutrition group was significantly higher than that of the parenteral nutrition group (P<0.05).6. The thickness of colonic mucosa decreased after operation, and inflammatory cells increased compared with control group. However, the thickness of coloic mucosa in early enteral nutrition group was significantly higher than that of parenteral nutrition group (P<0.05).7. Higher bacterial translocation rates in the mesenteric lymph nodes were observed after operation. enteral nutrition significantly lower bacterial translocation compared to the parenteral nutrition (P<0.05).8. The IgA+ cells in the rat ileum, colon immunohistochemical lamina propria were lower after operation compared to preoperative, however, the amount of IgA+ cells in the enteral nutrition group significantly higher than that of the parenteral nutrition group (P<0.05).Conclusion:1. Traumatic stress from abdominal surgery led to intestinal barrier dysfunction in patients. Completely parenteral nutrition can cause lack of glutamine intestinal mucosa, influence postoperative recovery.2. After abdominal operation, intestinal barrier function in rats was significantly impaired. The intestinal mucosa lamina propria IgA+ cells, bacterial replacement decrease in the number of the increase. Thus can infer that intestinal sIgA content and intestinal mucosa injury, intestinal bacterial replacement closely related. Postoperative enteral nutrition can significantly increase IgA+ cells quantity, reduce bacterial replacement.3. There was a significant protective effect on gut barrier with early enteral nutrition. |
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