The Experimental And Clinical Study In Effects Of Nutritional Supporting Strategies On Pancreato-surgery Diseases

There exists great controversy about how to maintain nutrition supporting to pancreatic diseases at present.Although enteral nutrition is more suitable to human physical digest procedure,pancreatic external secretion regulation function is complicated,so there are different opinions in the time selection of enteral nutrition in pancreatic diseases.Traditional opinion believed that the treatment should start with"pancreas resting",delay the enteral nutrition,decrease pancreatic external secretion volume.However,some believed that enteral nutrition didn't exacerbate the pancreatic damage when avoiding gastro and duodenum.No matter whether the patients of pancreatic diseases have enteroparalysis or not,the enteral nutrition should be administrated at onset or within 24-48 hours postoperatively.Accordingly,the purpose of this study is to evaluate the treatment value of the enteral nutrition and parenteral nutrition to pancreatic diseases.OBJECTIVE:To establish rat acute pancreatitis model and observe the effects of different nutritional supporting strategies on pancreatic pathological and microcirculatory changes;to observe the influence of enteral nutrition on human pancreatic excrine function and to study the effect of different nutritional strategies on pancreato-surgery diseases.METHODS:(1)The bile-pancreatic ducts of rats were ligated,the catheters were inserted into right jugular vein and jejunum and the acute pancreatitis model was established.Forty pancreatitic rats were divided into four groups and were given simple parenteral nutrition(PN,n=10),early enteral nutrition(EEN,n=10), median enteral nutrition(MEN,n=10),and late enteral nutrition(LEN,n=10) respectively.After seven-days nutritional supporting,the rats' weight change and ascitic fluid was recorded,serum biochemistry index,pancreatic enzyme index, and malonaldehyde concentration were examined,and the pancreatitic tissue were stained with hematoxylin eosin,and histopathologically scored.(2)Another group of 15 rats accepting PN and EEN supporting were deeply anesthetized 3 days later and the pancreatic microcirculatory situation was observed in vivo.(3)Serum and pancreatic juice of patients undergoing pancreaticoduodenectomy were collected and pancreatic enzyme index before and after enteral nutrition through jejunum was examined.RESULTS:(1)The acute pancreatitis model in rat was successfully established. Three rats died in EEN group,and one rat died in MEN group.The weight reduction and ascitic fluid increase of EEN and MEN groups were significant compared with PN and LEN groups(P＜0.05).The index of direct bilirubin of EEN group was significantly higher than that of PN and LEN groups(P＜0.05). The index of serum albumin of PN group was higher than those of the other three groups(P＜0.05);the index of hemodiastase of PN group was lower than those of EEN and MEN groups(P＜0.05);the index of hemolipase of PN group was lower than those of the other three groups(P＜0.05).The amount of pancreatic tissue amylase of PN and LEN groups was lower than those of EEN and MEN groups(P＜0.05);the amount of pancreatic tissue lypase of EEN group was higher than those of PN and LEN groups(P＜0.05).There existed significant relativity between MDA concentration and histopathological score of pancreatic tissue (R=0.93,P＜0.05);MDA concentration and histopathological score of EEN and MEN groups were significantly higher than those of PN and LEN groups (P＜0.05).(2)Compared with PN group,following microcirculatory changes were observed in EEN group in vivo status:interlobular artery and vein structures disappeared,the vessel course was distorted and deformed;intralobular vessels were twisted into nidus,there was patchy bleeding around the vessel combined with necrosis;microcirculatory structures of pancreatic island disappeared and pancreatic tissue necrotized;capillary network had bleeding and necrosis.(3)The concentration of amylase and lypase in pancreatic fluid of patients undergoing pancreaticoduodenectomy indicated that:the concentration of amylase and lypase before EN were significantly lower than that after EN(paired t-test,P＜0.05). There was relativity between EN starting time and patient age(R=0.58,P＜0.05).CONCLUSIONS:Early enteral nutritional supporting could exacerbate histopathological changes of acute pancreatitic rats;excrine function could be stimulated after EN through jejunum when patients undergoing pancreaticoduodenectomy;regarding the pancreato-surgery diseases,simply pursuing early EN will endanger the pancreatic tissue,rather than bring advantage: the cost is more than award.When using EN,we should comprehensively consider energy demanding,pancreatic pathological changes,and its effect on gastrointestinal function.Based on individual condition,nutritional supporting strategies should be optimized,which is in favor of the rehabilitation of pancreatic diseases.