The Effect And Mechanism Of Early Enteral Nutrition On The Gastrointestinal Motility Of Rats With Severe Acute Pancreatit

Objective:To explore the effect and mechanism of early enteral nutrition on thegastrointestinal motility of rats with SAP(severe acute pancreatitis).Methods:90male Sprague-Dawley(SD) rats,about250g,were randomly divide into threegroups:the control group(C group,n=18cases),the parenteral nutrition group (PNgroup,n=18cases),the enteral nutrition group(EN group, n=54cases).The EN groupwere randomly divided into three groups(EN1,EN2,EN3,n=18cases)by the time ofenteral nutrition,received enteral nutrition in the postoperative second day,forthday,sixth day.Build SAP model by antidromic injected3.5%sodium taurocholate inthe pancreatic duct.Kill rats in the three time points:the third day,the fifth day,theseventh day(six in every group),collect blood serum to text amylase(AMS),assay wasrestored at-80℃for TNF-α,MTL,CCK and VIP by ELISA.Pancreas and smallintestine tissue were fixed in4%formalin for pathological examination.Results:1.About MTL,the level of C group is higher than the EN and PN group all thetime(P<0.01);The EN1group is higher than other groups(P<0.05) in the fifth day;Thelevel of PN group and EN3group is lower than EN1and EN2groups in the seventhday(P<0.01),the EN1group is higher than the EN2group and EN3group(P<0.05).Thelevel of MTL in EN group rises faster than the PN group.2.The level of CCK in C group is lower than the EN and PN group all thetime(P<0.01);The PN group is higher than the EN1and EN2group in the fifthday(P<0.01),the EN1group is lower than the EN3group and EN2group(P<0.05);The level of PN group is higher than EN group in the seventh day(P<0.01),the EN3groupis highest in EN group.The level of CCK in EN group drops faster than the PN group.3.The level of VIP in C group is lower than the EN and PN group all thetime(P<0.01);The PN group is higher than the EN1and EN2group in the fifthday(P<0.05),the EN2and EN3group is higher than theEN1group (P<0.05);The levelof PN group is higher than EN group in the seventh day(P<0.05),the EN3group ishighest in EN group,the EN1group is the lowest(P<0.01).The level of VIP in ENgroup drops faster than the PN group,the sooner the better.4.About AMS,the level of C group is higher than the EN and PN group all thetime(P<0.01);The EN1group is lower than the PN group in the third day (P<0.05);The level of PN group is higher than the EN1and EN2group in the fifthday(P<0.01),the EN1group is the lowest in EN group and the EN3group is thehighest(P<0.01);The EN group is lower than the PN group(P<0.01);The level of AMSin EN group drops faster than the PN group.5.About TNF-α,the level of C group is lower than the EN and PN group all thetime(P<0.01);The EN3and PN group is higher than the EN1and EN2group in thefifth day(P<0.01),the EN1group is lower than the EN2group and EN3group(P<0.01);The level of PN group is higher than EN group in seventh day(P<0.01),theevery one in EN group is different with the others(P<0.01).The level of TNF-α in ENgroup drops faster than the PN group.6.About the pathological score of pancreas,the level of C group is lower than theEN and PN group all the time(P<0.01);The EN1group is lower than PN group in thethird day(P<0.05);The EN1group is lowest in all groups in the fifth day (P<0.01),theEN2group is lower than PN group(P<0.05);The level of PN group is higher than ENgroup in seventh day(P<0.01),the EN3group is lowest in EN group (EN1,P<0.01;EN2,P<0.05).The level of pathological score of pancreas in EN group dropsfaster than the PN group,the sooner the better.7.About the pathological score of small intestine,the level of C group is lowerthan the EN and PN group all the time(P<0.01);The level of EN1group is lower thanthe PN group in the third day(P<0.05);The EN1and EN2group is lower than the PN group in the fifth day(P<0.01),the EN1group is the lowest of EN group(P<0.05);Thelevel of PN group is higher than EN group in the seventh day(P<0.05),the EN3groupis higher than the EN1group and EN2group,the EN1group is the lower than the EN2group and EN3group(P<0.05).The pathological score in EN group drops faster thanthe PN group.8.Spearman rank correlation analysis show:The pathological score of pancreas ispositively correlated with the pathological score of small intestine(r=0.925, P<0.01).The pathological score of pancreas and small intestine is negatively related tothe level of MTL(r=-0.777,P<0.01;r=-0.723,P<0.01).The level of CCK and VIP ispositively correlated with the pathological score of pancreas(r=0.960,P<0.01;r=0.954,P<0.01).Conclusion:1.The early EN can reduce pancreatic inflammatory reaction,protect intestinalmucosa barrier,in favor of gastrointestinal motility.2.The early EN can improve the gastrointestinal motility by regulating the levelof gastrointestinal hormone.