失血性休克复苏后肠内给予特殊营养物对肠粘膜血流量的影响

为探讨失血性休克复苏后肠内营养与肠粘膜血流改变的关系 ,从SD大鼠开腹制作空肠袋 ,将激光多谱勒探头和肠粘膜张力计放置在空肠袋两端 ,根据动物分组分别向袋内注射葡萄糖、谷氨酰胺、丙氨酸及甘露醇。复制失血性休克模型 (30mmHg ,维持 6 0min) ,然后用林格氏液复苏 ,恢复灌流 6 0min。分别测定肠粘膜血流量和局部PCO2 张力 (PrCO2 )。结果显示 ,失血性休克和复苏过程中 ,谷氨酰胺和葡萄糖组粘膜血流量比甘露醇和丙氨酸组显著增加 ,PrCO2 显著降低 ;而肠内给予丙氨酸进一步降低肠粘膜血流量 ,升高PrCO2 。提示 :失血性休克复苏后 ,肠内给予丙氨酸减少肠粘膜血流量 ;而给予谷氨酰胺和葡萄糖能增加肠粘膜血流量 ,对缺血再灌流损伤的肠道提供保护作用

Effect of Enteral Nutrients on Gut Mucosal Blood Flow Following Hemorrhagic Shock and Resuscitation

To determine if the specific nutrients were associated with alterations in mucosal perfusion following hemorrhagic shock and resuscitation, Sprague Dawley rats had either a laser Doppler probe or a tonometer inserted into a jejunal sac filled with 10 mM alanine, glutamine, glucose or mannitol respectively followed by 60 minutes of hemorrhagic shock and 90 minutes of resuscitation. Mucosal blood flow was significantly increased during both hemorrhagic shock and resuscitation when intraluminal glucose and glutamine were present as compared to intraluminal alanine. Blood flow changes were reflected by lower jejunal PrCO 2 measurements with intraluminal glucose and glutamine. The results indicated that intraluminal glucose and glutamine could augment mucosal blood flow, and provide the protective effect on gut from ischemia and reperfusion injury.