The Effect Of Early Enteral Nutrition On The Intestinal Mucosal Barrier And Heart Injury In Rats With Severe Acute Pancreatitis

Objective:To investigate the influence of early (12 hours after the model made ) enteral nutrition on the intestinal mucosal barrier and lung injury in rats with severe acute pancreatitis.Methods:48 healthy male Sprague-Dawley rats (180-200g weight) were randomly allocated into four groups: sham operation group(S group); parenteral nutrition group(PN group); giving enteral nutrition 12h after operation (EEN group); giving enteral nutrition 24h after operation (EN group); In addition,32 healthy male Sprague-Dawley rats (180-200g weight) were randomly allocated into above- mentioned four groups to observed the survival rate among 5days;The model of SAP was induced by injection of 1ml of 3.8%sodium taurocholate beneath the pancreatic capsule.Sham-operated animals was executed operation,but nothing was injected, pancreas was just flipped and striked gently a few times.Rats were killed by abdominal aorta exsanguination at 3d and 5d after operation .The levels of serum amylase were measured,other blood serum for ELISA and DAO and D-lactate , assay was restored at -80℃, pancreatic and lung and ileum tissue was fixed in 4% formalin, the expression of lung TNF-αprotein was examinated by immunohistochemistry, and observed the effects of early enteral nutrition on them.Results:1. Four groups of rats 5d survival rate: the survival rate of rats of S Section 5d was 100%, while that of PN, EN, EEN group after being made model were 50%, 62.5%, 75%, S group and the remaining three group comparison of survival rates were significantly different (P<0.01); and PN, EN, EEN group comparison between the survival rates, there was no significant difference (P>0.05),which shows that early enteral nutrition is security.2. Serum amylase change: After the model ,the level of serum amylase of PN,EN and EEN group in various time points were significantly higher compared with the S group,which was significant statistical difference (P<0.01); at all time points, EEN, EN group and PN group, although the lower content of amylase, but no statistical significance (P>0.05); EEN group and the EN group, no statistically significant difference (P>0.05).3. Pancreatic histological score: the S group, PN,EN and EEN group at different time points were significantly increased, compared with the S group there was a significant difference (P<0.01);and PN group, EN, EEN group low score, EEN 3d group, EN 5d group and PN group corresponding point in time there is significant difference compared to (P<0.05); in EEN group 5d, when compared with the PN group were significantly difference (P<0.01), EEN group compared with the EN group significant difference (P<0.05).4.CK-MB change: The level of S group is lower at different time points,and no significant change (P> 0.05); PN, EN, EEN group was significantly higher with the S group compared with the low point in time, there was a significant difference (P <0.01); EN group, EEN group after 3d downward trend, 3d group, 5d group than in PN group at the same time, the difference was statistically significant (P <0.05); EN group 3d, 5d group was lower than the same time point EEN group, but the difference was not statistically significant (P> 0.05); EN, EEN group than 3d time 5d point in time the same group, the difference was statistically significant (P <0.05).5.Heart morphological change: S group is not significant changafter the model at different time points e in myocardial; PN, EN, EEN group of the first three days can be seen clearly in congestive cardiomyopathy, swelling, and some myocardial fiber breakage, necrosis, a large number of inflammatory cell infiltration, and focal hemorrhage; the first five days still can be seen clearly in congestive cardiomyopathy, swelling, and some myocardial fiber breakage, necrosis, a large number of inflammatory cell infiltration, and focal hemorrhage, but the first three days to alleviate; PN group than in EN, EEN group slightly heavy; PN group, EN, EEN group of patients Science score was not significant (P> 0.05).6. on the fifth day, PN group mucosa thickness and villus height are significantly lower than the EEN group, the difference was significant (P<0.01); the mucosa thickness and intestinal villi height of EEN group and EN group has significant difference (P<0.05) .7. Serum levels of TNF-αchange: After the model PN,EN and EEN group serum levels of TNF-αcompared with the S group in all time points were significantly higher (P<0.01); EEN 3d group, EN 5d group and PN group corresponding point in time there is significant difference compared to (P<0.05); in 5d EEN group when compared with PN group statistically significant differences (P<0.01), EEN group compared with the EN group significant difference (P<0.05).8. Plasma D-lactic acid change: plasma D-lactate levels of S group rats lower, in the model at each time point after was no significant change, and at all time points significantly lower than the PN, EN, EEN group, the difference There was a significant statistical significance (P<0.01); on the 3d, 5d when the EEN group the level of plasma D-lactate than the PN group was lower, There was a significant difference (P<0.01); on the 3d when the EN group than in PN group significantly decreased, the difference was statistically significant (P<0.05); on the 5d when the EN group than in PN group also decreased significantly, the difference was significant of statistical significance (P<0.01); on the 5d when the EEN group plasma D-lactate levels than the EN group has improved, the difference was statistically significant (P<0.05).9. Serum DAO change: After the model, S group in all time points no significant change, PN,EN group in 3d , 5 d time point was significantly lower than the S group, significant differences were statistically significant (P<0.01); on the 3d when the EEN group than in PN group increased, the difference was statistically significant (P<0.05); on the 5d when the EEN group than in PN group also increased significantly, there were significant differences in statistical significance (P<0.01); in the EN group on the fifth day serum diamine oxidase levels than that of in the PN group, the difference was statistically significant (P<0.05 ); on the fifth day the serum diamine oxidase levels of EEN group was statistically significant than that of EN group, (P<0.05).10.Heart TNF-αprotein content change: After the model PN, EN and EEN group TNF-αprotein content were significantly higher than the S group in all time points (P<0.01);the third day were the highest. The protein content of PN,EEN and EN have on difference(P>0.05). Conclusions:(1)The results of our study demonstrated that early enteral nutrition was feasible and safe,and did not aggravate pathogenetic condition of pancreatitis,it may be applied at early period. (2)Early enteral nutrition could protect intestinal mucosal barrier。(3)EEN have some protective effect on injury in rat heart of SAP, but not reduced heart tissue levels of TNF-αof heart.