免疫营养对烫伤鼠肠粘膜的保护作用及其在烧伤病人中的应用
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摘要
研究背景与总体思路
烧伤后的应激性变化可造成肠粘膜的缺血性损害，肠粘膜屏障的破坏，细菌和内毒素就易于渗过肠粘膜屏障，作用于补体系统，产生数量众多的降解产物，这些物质可引起内脏血流的进一步下降，出现恶性循环。因此Wilmore等提出了“肠道是应激的中心器官”学说；认为应激时肠管呈短暂或长时间的屏障功能损害，肠粘膜萎缩、通透性增加，细菌和毒素穿越肠粘膜屏障移行到肠系膜淋巴结或其他远处脏器形成细菌易位，促进了全身炎症反应综合征(SIRS)的发生，通过一系列级联反应可最终导致多器官功能不全综合症(MODS)。
烧伤后肠道是高代谢反应的中心器官之一，如没有足够的营养维护肠道结构与功能，则肠粘膜屏障功能易受损害，使营养物质的吸收和利用发生障碍，以致内脏蛋白质过度消耗，免疫功能受抑制，创面愈合延迟，在缺乏肠道营养支持的前提下，加重了肠道纽菌和内毒素易位，以致全身感染和脏器功能受损。同时，烧伤后组织严重损毁，以及受剧烈应激反应时各种神经内分泌因素的影响，机体在糖、蛋白质、脂肪等代谢方面都发生一系列极为复杂的变化，一方面组织分解加剧，蛋白质大量丢失，能量消耗增加，代谢率升高；另一方面机体恢复及创面修复时也需要大量的营养物质。因此对烧伤病人实行有效的营养支持，保护肠道粘膜，维持肠道屏障功能的完整性，减少细菌和内毒素的易位，降低创伤后高代谢反应，改善机体的营养状态已成为烧伤治疗中的一个主要环节之一。
近十年来，随着临床营养学的发展和对机体代谢的深入认识，免疫营养
Background and Research Strategy
The stress response after burns would arouse ischemic damages in intestinal mucosa and induce endotoxin/bacteria translocation, which affected complement system and produced redundant degradation products, and resulted to obviously lower in visceral bloodflow,those materials caused vicious cycle between inflammatory factor and host. So Wilmore preferred that intestine was the center organ at stress state; they thought barrier dysfunction in intestine would promoted occurrence of SIRS and MODS by a series of cascade reactions.
As intestinal tract were the center organ of hypermetabolism after burns, the intestinal mucosa were damaged without sufficiently nutritive substrates, which effected absorption and utilization of nutritive substances, and restrained immunological function indirectly, At the same time endotoxin/bacteria translocation were aggravated, systemic infection and damaged in organ' s function were induced.
Because of severely damage in tissue and changes secondarily in neuroendocrine after burns, there proceeded a series of complicated diversify in metabolism among glyco,proteins and fat, tissue disintegration were aggravated, protein lossed greatly, on the other hand, the requirement for nutritive substances were augmented for wound healing. So effective nutritional support became a central aspect of treatments in burns patients.
烧伤后的应激性变化可造成肠粘膜的缺血性损害，肠粘膜屏障的破坏，细菌和内毒素就易于渗过肠粘膜屏障，作用于补体系统，产生数量众多的降解产物，这些物质可引起内脏血流的进一步下降，出现恶性循环。因此Wilmore等提出了“肠道是应激的中心器官”学说；认为应激时肠管呈短暂或长时间的屏障功能损害，肠粘膜萎缩、通透性增加，细菌和毒素穿越肠粘膜屏障移行到肠系膜淋巴结或其他远处脏器形成细菌易位，促进了全身炎症反应综合征(SIRS)的发生，通过一系列级联反应可最终导致多器官功能不全综合症(MODS)。
烧伤后肠道是高代谢反应的中心器官之一，如没有足够的营养维护肠道结构与功能，则肠粘膜屏障功能易受损害，使营养物质的吸收和利用发生障碍，以致内脏蛋白质过度消耗，免疫功能受抑制，创面愈合延迟，在缺乏肠道营养支持的前提下，加重了肠道纽菌和内毒素易位，以致全身感染和脏器功能受损。同时，烧伤后组织严重损毁，以及受剧烈应激反应时各种神经内分泌因素的影响，机体在糖、蛋白质、脂肪等代谢方面都发生一系列极为复杂的变化，一方面组织分解加剧，蛋白质大量丢失，能量消耗增加，代谢率升高；另一方面机体恢复及创面修复时也需要大量的营养物质。因此对烧伤病人实行有效的营养支持，保护肠道粘膜，维持肠道屏障功能的完整性，减少细菌和内毒素的易位，降低创伤后高代谢反应，改善机体的营养状态已成为烧伤治疗中的一个主要环节之一。
近十年来，随着临床营养学的发展和对机体代谢的深入认识，免疫营养
Background and Research Strategy
The stress response after burns would arouse ischemic damages in intestinal mucosa and induce endotoxin/bacteria translocation, which affected complement system and produced redundant degradation products, and resulted to obviously lower in visceral bloodflow,those materials caused vicious cycle between inflammatory factor and host. So Wilmore preferred that intestine was the center organ at stress state; they thought barrier dysfunction in intestine would promoted occurrence of SIRS and MODS by a series of cascade reactions.
As intestinal tract were the center organ of hypermetabolism after burns, the intestinal mucosa were damaged without sufficiently nutritive substrates, which effected absorption and utilization of nutritive substances, and restrained immunological function indirectly, At the same time endotoxin/bacteria translocation were aggravated, systemic infection and damaged in organ' s function were induced.
Because of severely damage in tissue and changes secondarily in neuroendocrine after burns, there proceeded a series of complicated diversify in metabolism among glyco,proteins and fat, tissue disintegration were aggravated, protein lossed greatly, on the other hand, the requirement for nutritive substances were augmented for wound healing. So effective nutritional support became a central aspect of treatments in burns patients.
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