Role of Gut after severe surgical stress

严重创伤后的实验性ISepsis常导致多系统器官衰竭（MSOF）和死亡。这种临床表现的连续性导致了MSOF发展的“两次打击”或“第二次攻击”理论的想法。我们研究了细菌易位（BT）和细胞因子的反应，在大鼠第二次攻击模型，看看营养供应的时间和途径可以调节这些respons.Methods：大鼠（n=57）进行中线剖腹手术，并在术后挑战IP。动物分为S1组（术后第1天给予酵母菌活菌）和S3组（术后第3天给予酵母菌活菌活菌），每组又分为TPN组、TEN组和C组。TPN和TEN大鼠剖腹后接受等热量等氮营养。C组给予标准大鼠饲料。酵母多糖攻击后18 h，大鼠灌胃108 E。大肠杆菌和sacr ...更多信息 四个小时后被批准。收集肝脏、肠系膜淋巴结（MLN）、脾脏和血液。结果<table>术后早期（S1）细菌移位率和IL-6的产生率明显高于晚期（S2），肠内营养可降低细菌移位率和IL-6的产生。肠内营养在术后早期是最有效的，因为二次发作可能会导致严重的并发症，实验二在实验一的基础上，对全胃切除术或食管次全切除术后患者进行早期肠内营养支持。26例患者在术后24小时内开始肠内营养。在最初的12例患者中，POD 1和2时给予300 kcal/天，POD 3和4时给予600 kcal/天，POD 5后给予1200 kcal/天。2例患者在术后第4天停止肠内营养，2例患者在术后第5天因腹胀和/或腹泻减少肠内营养量。其余患者术后第5天开始给予900千卡/天的肠内营养，耐受性良好。结论：胃肠道手术后24小时内给予早期肠内营养对大多数患者是可行的。少

Experiment ISepsis that follows severe trauma often results in multiple system organ failure (MSOF) and death. The sequential nature of this clinical picture has led to the idea of a "two-hit" or "second attack" theory for the development of MSOF. We investigated bacterial translocation (BT) and cytokine responses in a rat second attack model and see if the timing and route of nutrition supply can modulate these responses.Methods: Rats (n=57) underwent midline laparotomy and were postoperatively challenged I.p. with zymosan as a second attack. Animals were divided into S1 (zymozan on POD1) and S3 (zymozan on POD3) group and each group of rats were further divided into TPN (total parenteral nutrition) group, TEN (total enteral nutrition) group and C (chow) group. After laparotomy TPN and TEN rats received isocaloric and isonitrogenous nutrition. Rats in C group were provided standard rat chow ad libitum. Eighteen hours after zymosan challenge, rats were gavaged with 108 E. coli and sacr … More ificed four hours later. Liver, mesenteric lymphnode (MLN), spleen and blood were harvested. BT and cytokine levels in the organs were determined.Results <<table>>Early occurrence of postoperative second attack (S1) resulted in higher incidence of bacterial translocation and u regulated IL-6 response than in the late occurrence of second attack (S2), Nutrition supply by enteral route decreased translocation of bacterial and IL-6 production.Conclusion: Nutrition supply by enteral route appeared to be most useful in the early postoperative course when the occurrence of second attack may cause serious consequences.Experiment IIOn the basis of experiment I, post operative early enteral nutrition was performed to those underwent total gastrectomy or subtotal esophagectomy. Enteral nutrition was initiated in 26 patients within 24 hours after surgery. In the initial 12 patients, 300 kcal/day was administered on POD 1 and 2, 600 kcal/day on POD 3 and 4, 1200 kcal/day after POD 5. Enteral nutrition was discontinued in two patients on POD 4 and the amount was decreased in two patients on POD 5 because of abdominal distention and/or diarrhea. In the rest of patients, 900 kcal/day was administered after POD 5 and they were well tolerated.It is concluded that early enteral nutrition within 24 hours post gastrointestinal surgery was possible in the majority of patients. Less