【作者】 吴抽浪；

【导师】 郭光华；

【作者基本信息】 江西医学院 ， 烧伤外科， 2003， 硕士

【摘要】 目的：探讨早期肠内营养联合重组人生长激素对严重烫伤大鼠的作用。方法：成年健康 wistar 大鼠130只，雌雄不拘，260-300g，适应性喂养一周，随机分为伤前正常组（N组,n=10）、对照组（C组，n=40）、早期肠内营养组（EEN组，n=40）及早期肠内营养+重组人生长激素组（EEN+rhGH组，n=40），单笼喂养，自由饮水。N组禁食12小时麻醉称重后活杀取血，检查白细胞、血红蛋白、总蛋白及白蛋白并分离血清。C组、EEN组、EEN+rhGH组均给予30%TBSAⅢ。背部烫伤（病理切片证实），每组均分为伤后第1、3、5、9天四个时相点，每个时相点10只。烫伤后C组大鼠自由进食饲料，EEN组及EEN+rhGH组大鼠灌喂牛奶，各组大鼠热卡均按每鼠735KJ/Kg.d计算，EEN组大鼠每鼠每晚皮下注射生理盐水0.1ml, EEN+rhGH组大鼠每鼠每晚皮下注射重组人生长激素（长春金赛药业公司生产）0.3U/Kg，于伤后第1、3、5、9天麻醉称重后活杀取血，检查白细胞、血红蛋白、血清总蛋白及血清白蛋白并分离血清，同时取部分回肠肠管行形态学观察。所得血清用以测定内毒素、TNFa含量，其中内毒素用上海伊华公司的鲎试剂盒检测，TNFa用深圳晶美公司的大鼠ELISA试剂盒检测。结果：1、与N组比较，伤后第1天，C组体重显著下降(P<0.05)；<WP=4>伤后第3、5天，各组体重均显著下降(P<0.05-0.01)；伤后第9天，C组和EEN组体重仍显著下降(P<0.01)，但较第5天有所回升,EEN+rhGH组则无显著差异。2、伤后第1、3天，C组肠粘膜坏死脱落，EEN组肠粘膜充血，炎症反应较重，EEN+rhGH组仅见炎性细胞浸润；第5天见各组肠粘膜均完整，但C组几乎看不到肠腺体；第9天，各组肠粘膜均完整，绒毛生长，但EEN+rhGH组绒毛高度明显高于其它组。3、烫伤后各组大鼠血清内毒素水平较伤前正常组（N组）显著上升（P<0.01）。EEN组、 EEN+rhGH组大鼠血清内毒素水平在各时相点均低于C组，有显著差异（P<0.01），EEN+rhGH组大鼠血清内毒素水平在各时相点均低于EEN组，但无显著差异；4、各组大鼠血清TNFa水平较伤前正常组（N组）显著上升（P<0.01）。EEN组大鼠血清TNFa水平在各时相点均低于C组,在第1、5、9天有显著差异（P<0.05-0.01），EEN+rhGH组血清TNFa水平在各时相点均低于C组，有极显著差异（P<0.01）。EEN+rhGH组血清TNFa水平在各时相点低于EEN组，在第3、9天有显著差异（P<0.05-0.01）。5、伤后第9天，EEN+rhGH组创面明显缩小，C组和EEN组则不明显。结论：1、严重烧(烫)伤后，积极的早期肠内营养可保护肠道的结构和功能，减轻炎症反应和高代谢反应；2、早期肠内营养联合重组人生长激素在维持肠粘膜完整性、促进绒毛生长、降低严重烧(烫)伤后炎症反应和高代谢反应及促进创面愈合等方面，优于单纯肠内营养。更多还原

【Abstract】 Objective To explore the effect of early enteral nutrition(EEN) with recombinant human growth hormone(rhGH) on severely scalded rats. Methods 130 wistar rats were randomly divided into four groups, i.e. normal (N,n=10),control(C,n=40),early enteral nutrition(EEN,n=40) and early enteral nutrition with rhGH(EEN+rhGH,n=40).The rats in C,EEN and EEN+rhGH groups were inflicted with 30% TBSA Ⅲ degree scalding on the back and the indices were observed on 1,3,5,9 postburn day (PBD)(n=10,respectively).Equal amount of calories were applied via free feeding to those in N and C groups or compulsory early enteral feeding to those in EEN and EEN+rhGH groups. The scalded rats were administered subcutaneously with normal saline(0.1ml/d) and rhGH(0.3u/kg.d) every evening, respectively in EEN and EEN+rhGH groups. The changes of body weight, morphology of ileal mucosa, serum endotoxin and serum TNFa and others were observed. Results 1 The body weight of those in C group decreased significantly on PBD1, PBD3, PBD5 and PBD9(P<0.05-0.01), The weight of those in EEN group decreased significantly on PBD3, PBD5 and PBD9(P<0.01),and The body weight of those in EEN+rhGH group decreased significantly only on PBD3 and PBD5(P<0.05-0.01). 2 Intestinal mucosal<WP=6>injury and necrosis were observed in C group, and Intestinal mucosal inflammatory response was observed in EEN group. 3 The levels of serum endotoxin in C,EEN and EEN+rhGH groups were higher than that in N group (P<0.01),The levels of serum endotoxin in EEN and EEN+rhGH groups were lower than that in C group(P<0.01) ,and the level of serum endotoxin in EEN+rhGH groups was lower than that in EEN group.4 The levels of serum TNFa in C,EEN and EEN+rhGH groups were higher than that in N group (P<0.01), The level of serum TNFa in EEN group was lower than that in C group on PBD1、 PBD5 and PBD9(P<0.01), and The level of serum TNFa in EEN+rhGH group were lower than that in C group (P<0.01) and lower than that in EEN group (P<0.05-0.01).5 The sizes of the wound in EEN+rhGH group were much smaller than those in C group and EEN group.Conclusion 1 aggressive early enteral postburn nutrition could protect the intestine , maintain its function, promote the growth of the mucosa and amelorate the inflammatory response and hypermatabolic response. 2 EEH with rhGH was prior to EEH in protecting the intestine , maintaining its function ,promoting the growth of the mucosa, ameliorating the inflammatory response and hypermatabolic response and promoting the wound healing.更多还原