Study On The Influence And Mechanism Of Early Enteral Nutrition In Different Periods To Intestinal Mucosal Barrier Functions Of Rats With Severe Acute Pancreatitis

Objective:This paper, by taking rat model, makes a study to the influencing mechanism ofearly enteral nutrition in different periods to intestinal mucosal barrier structures andfunctions at the time of severe acute pancreatitis and discusses the protectivemeasures, hoping to provide theoretical basis and experimental basis for clinictreatment.Method:75male SD rats were selected as the research objects, and they were dividedinto three groups: experimental group (EN group/SAP+EN)(n=45)(EN1, EN2andEN3groups respectively stood for3starting time, and each group included15rats),control group (TPN group/SAP+TPN)(n=15), blank group (S group/sham operationgroup)(n=15). Fistulization was carried out to rats of all groups with jejunum, venouscatheter was made in the neck. Rats in the sham operation group only had theirviscera turned, while those in the experimental group and control group were injectedwith3.5%sodium taurocholate solutions by retrograde injection to establish severeacute pancreatitis model. After successful modeling, rats in the control group weretreated with total parenteral nutrition, while rats in the experimental group, includingEN1group, EN2group and EN3group (n=15) were treated with enteral nutritionrespectively in one day, two days and four days after SAP modeling; their protectivefunctions to intestinal mucosal barrier of SAP rats were observed and compared, andafter one day of the experimental nodes, that is on the second day, third day and fifthday,5rats were killed in each group. Then their heart blood sampling were taken tomeasure the white blood cell count and amylase, then ELISA was taken to test the ET, TNF-α, IL-2and IL-10, then pancreas and jejunum mucosa section staining weretaken to carry out histopathologic examination.Results:1. General conditions:Rats in the blank group have good reaction after operation, and there was nosignificant difference among the times nodes; Rats in the experimental group gotbetter improvement then those in the control group, but they were no better than thosein the blank group.2. Haematological indexThe serum amylase of rats in the blank group was slightly lower, and there wasno significant difference among the time nodes; when comparing the time nodes ofthe experimental group (EN) and the control group (TPN), it could be seen that theirblood amylase and blood routine values changed along with the time, the variationtrends of all indexes were basically the same, and AMS and WBC, etc. were all on adeclining curve and returned to normal gradually; before the time nodes, thedifference between EN group and TPN group had no statistic value, but they wereboth higher than the S group; after the time nodes, the EN group was significantlylower than the TPN group in various time periods; after comparison among subgroupsof EN group, it was seen that the AMY and WBC levels decreased gradually withtime, and EN1group was significantly lower than the EN2and EN3group.3. Serum ET, TNF-α, IL-2, IL-10changes:Changes of various groups indicated that: the serum level of the blank group waslower than that of the experimental group and control group, and there was nodifference between the experimental group and control group; there was no significantdifference in TPN group and EN group in the first day; the ET, TNF-α, IL-2andIL-10levels of the blank group in the third day were significantly lower than those ofthe other groups, and after treatment, those of EN group were lower than those of theTPN group. Those of the EN group decreased from the second day, and there was significant difference compared with the parenteral nutrition group. There wasobvious difference between the EN1group, EN2group and the EN3group.4. Histological observation of Pancreas and jejunum:Pancreatic histological scores of TPN and EN groups at every time point weresignificantly higher than that of S group; Pancreatic histological scores of EN groupwere lower than that of TPN group at the corresponding time points; the scores ofEN3group were higher than that of EN1and EN2.The jejunum pathology scores ofEN1and EN2groups at the third day and the fifth day were significantly lower thanthat of EN3group and other groups.Conclusion:1.When the basic situation of rats with severe acute pancreatitis is stable, to useearly enteral nutrition is conducive to the function of intestinal mucosa barrier, andthe earlier the better;2.Early enteral nutrition can reduce local tissue damage, reduce the reactiondegree of inflammation and prevent intestinal bacterial translocation, which isconducive to protect the structure and function of intestinal mucosa.