ROLE OF EARLY ENTERAL FEEDING AND ACUTE STARVATION ON POSTBURN BACTERIAL TRANSLOCATION AND HOST-DEFENSE - PROSPECTIVE, RANDOMIZED TRIALS
ROLE OF EARLY ENTERAL FEEDING AND ACUTE STARVATION ON POSTBURN BACTERIAL TRANSLOCATION AND HOST-DEFENSE - PROSPECTIVE, RANDOMIZED TRIALS
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DOI：
10.1097/00003246-199402000-00018
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发表时间：
1994-02-01
影响因子：
8.8
通讯作者：
CHALK, CL
中科院分区：
文献类型：
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作者：
GIANOTTI, L;ALEXANDER, JW;CHALK, CL
目的：调查以下因素的影响：a）烧伤前饥饿和B）烧伤后立即肠内营养对肠道对微生物的渗透性和宿主杀死易位细菌的能力的影响。设计：前瞻性、随机、实验性试验。设置：实验室。受试者：Balb/c小鼠和Hartley豚鼠。干预措施：在第一个实验中，小鼠在接受10（10）C-14标记的大肠杆菌和20%烧伤的管饲之前饥饿0、6、12、18或24小时。在第二个实验中，豚鼠接受40%烧伤，并随机接受完全肠内饮食（175 kcal/kg/天）或通过先前放置的胃造口术输注等体积的乳酸林格氏溶液，持续6、24或48小时。每个喂养期后，灌胃输注10（10）C-14大肠杆菌。在两个实验中，在管饲后4小时处死动物，并无菌收获肠系膜淋巴结、脾、肝、肺、腹膜液和血液。测量：对于每种组织或液体，活的E.大肠杆菌和C-14 E的放射性核素计数。大肠杆菌的数量，并计算存活的易位细菌的百分比。主要结果：在小鼠中，18和24小时的预烧饥饿增加易位仅肠系膜淋巴结，但它也增强了所有测试组织中的细菌杀灭。与输注乳酸林格氏溶液的动物相比，在烧伤后6、24和48小时经肠内喂养的豚鼠在所有组织中具有显著较低的细菌移位。此外，在喂养24和48小时后观察到对移位生物体的增强的杀灭。结论：烧伤前饥饿与烧伤后饥饿对细菌移位和杀灭作用不同。烧伤后肠内营养通过双重机制减少组织中活菌的负荷：最初减少易位，随后提高杀死易位细菌的能力。
Objectives: To investigate the effect of: a) starvation during the preburn period and b) immediate postburn enteral nutrition on the permeability of the gut to microorganisms and the ability of the host to kill translocated bacteria. Design: Prospective, randomized, experimental trials. Setting: Laboratory. Subjects: Balb/c mice and Hartley guinea pigs. Interventions: In the first experiment, mice were starved for 0, 6, 12, 18, or 24 hrs before receiving gavage with 10(10) C-14-labeled Escherichia coli and a 20% burn injury. In the second experiment, guinea pigs received a 40% burn injury and were randomized to receive a complete enteral diet (175 kcal/kg/day) or infusion of an equal volume of lactated Ringer's solution via a previously placed gastrostomy for 6, 24, or 48 hrs. After each feeding period, 10(10) C-14 Escherichia coli were infused intragastrically. In both experiments, the animals were killed 4 hrs after gavage, and mesenteric lymph nodes, spleen, liver, lungs, peritoneal fluid, and blood were harvested aseptically. Measurements: For each tissue or fluid, the number of viable E. Coli and radionuclide counts of the C-14 E. coli were measured and the percentage of translocated bacteria that remained alive was calculated. Main Results: In mice, 18 and 24 hrs of preburn starvation increased translocation only to the mesenteric lymph nodes, but it also enhanced bacterial killing in all tested tissues. Guinea pigs that were fed enterally for 6, 24, and 48 hrs postburn had significantly lower bacterial translocation in all tissues compared with animals infused with lactated Ringer's solution Additionally, enhanced killing of translocating organisms was observed after 24 and 48 hrs of feeding. Conclusions: Starvation preburn has different consequences than starvation postburn on translocation and bacterial killing. Postburn enteral nutrition decreases the load of viable bacteria in the tissues via a double mechanism: an initial decreased translocation and a subsequent improved ability to kill bacteria that do translocate.