摘要
严重创伤或烧伤后高分解代谢的机理仍不十分清楚。近几年，肠道与这种高代谢反应的关系虽引起人们的注意，但尚缺乏充足的理由和证据以阐明。笔者设计了一个小型猪实验模型，分别在门静脉、肠系膜下静脉及中心静脉插入导管，以获得不同区域的血标本，使肠道、肝脏（尤其是单核吞噬细胞系统）及全身代谢变化的观察成为一个既相对独立又互相关联的整体。结果表明，延迟喂养（ＤＦ）组动物伤后代谢率明显升高，伤后１０天，ＲＥＥ达伤前的１９８％，２４小时尿３－Ｍｅｈｉｓ排量及血中分解代谢激素（胰高糖素、皮质醇）明显增加，合成代谢激素（胰岛素）明显降低，提示分解代谢明显升高。早期肠道喂养（ＥＦ）组动物在多数时相点代谢率、分解代谢激素、尿３－Ｍｅｈｉｓ排量明显低于ＤＦ组，而合成代谢激素则明显高于ＤＦ组。结果还表明，高代谢期间（ＰＢＤ７－１０）的代谢反应中，经肠道途径介导的至少占１／３（３５％），而肠道外途径介导的高代谢反应仍占较大比重，但肠道途径不容忽视。
In order to approach the effects of gut on hypermetabolic response, a new animal model was developed in this study. Selected was a specially bred miniswine (Guizhou Species) to which multiple catheterizations were applied for sampling different blood from portal, inferior mesenteric as will as jugular (central) veins. The animals were sustained with 30% Ⅲ degree burns of TBSA 7 days post the catheterizations and divided randomly into early feeding(EF) group, given a complete diet beginning from 2 hours postburn (N=6), and delayed feeding (DF) group, given the same diet initiating on PBD4 (N=6). Results showed there were increase of REE (resting energy expenditure) to almost twice the normal value (198%) on PBD 10, and urinary 3 Mehis excretion in 24hrs and some catabolic hormones (cortisol, glucagon etc) in blood, on the other hand, decrease of anabolic hormone (insulin), implicating the significant increase of catabolism. But REE and urinary 3 Mehis excretion significantly decreased by early enteral feeding. Our findings showed that during the hypermetabolism (PBD 7 10), the metabolic response mediated by 'intestinal way' was at least 35% while 'extra intestinal way' occupied the rest, indicating that the extra intestinal way might still stand on its important position.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
1994年第3期103-105,共3页
Chinese Journal of Trauma
