The Effect Of Microecology Supplement With Enteral Nutrition On Intestinal Failure Of Rats With Severe Acute Pancretitis

The severe acute pancreatitis(SAP) is a potential deathful disease,with the morbidity increased in recent years,which has a high mortality rate.The pathogenesis is not elucidated quite well until now,and there is no efficient treatment strategy.The gastrointestinal failure is the most frequence complications and often occurened before other organ's dysfunction.It is not only the local display,but also the trigger of developing and aggravating of the multisystem and organ failure(MSOF).More and more clinical evidences had confirmed that prevention and treat gastrointestinal failure in time will have great significance to reduce and prevent MSOF.Microecology supplements have been used to improve gastrointestinal function in recent years.The commonly used microecology supplements include probiotic, prebiotic and synbiotics.It can directly supply normal flora or selectively stimulate the growth and multiply of normal flora,inhibit the overgrowth and multiply of exogenous pathogenic and endogenous conditioned pathogen,prevent the initiate and development of endogenous infection.Microecology supplements also have the function of protecting intestinal barrier,promoting gastrointestinal motility,et al.However,the relation of microecology supplements and SAP has not be reported so far.Our research aim to investigate the effect of microecology supplements bifidobacteria,oatβ-glucan and enteral nutrition in the SAP rat with gastrointestinal failure(include intestinal barrier, intestinal motility and absorption).It will provide effective measure to prevent secondary infection,decrease mortality rate and improve prognosis.Therefore it has considerable theoretical and practical significance.On account of above theory,this research includes three parts.Part One Construction of SAP rat animal modelObjective:To establish suitable SAP rat animal model successfully for nutritional therapy study.The model should be stabilization,reliability,good repetitiveness.Method:Twenty healthy male SD rats(weight 300±10 gram) were randomly divided into the model group(10 rats) and control group(10 rats).The SAP model in rat was established by injection of 1ml of 3.8%sodium taurocholate beneath the pancreatic capsule.We distinguish the model success through determination of amylase and pancreatic histopathology transform.Result:Model group of blood plasm amylase increased dramatically after operation. There was significant difference between model group and control group(P＜0.05).The HE staining results showed there was pancreatic hemorrhage and necrosis,and the impairment was possessive.The mortality rate was stable within one week.The results showed that the method could establish SAP model with good reproducibility,and the model was suitable for nutrition therapeutic research.Conclusion:SAP rat model successfully prepared for nutritional therapy study, and it is the ideal SAP rat model. Part Two The effect of microecology supplement with enteral nutrition on intestinal barrier function of rats with severe acute pancretitis.Objective:To investigate the influences of probiotics,prebiotics and synbiotics supplement with enteral nutrition on the intestinal barrier function of rats with severe acute pancretitis.Method:Thirty Sprague-Dawley(SD) model rats of severe acute pancretitis, which had be administerated with enteral nutrition plus with prebiotics or probiotics 7 days were divided into five groups:EN group(1),prebiotics+EN group(2), probiotics + EN group(3),synbiotics + EN group(4) and control group(5) via jejunostomy.The nutrition support in the four groups was isonitrogen and isocaloric. Before sacrifice on the seventh day,vein blood was tested for endotoxin,DAO,TNF, and IL-6;Specimens of jejunum were obtained to measure the height of villi and the thickness of mucosa.Result:1,Plasm endotoxin:The level of plasma endotoxin decreased significantly in probiotics + EN group Compared with EN group and prebiotics+EN group(P＜0.05).The levels of endotoxin were lowered in synbiotics + EN group compared with control group,but there are no differences between synbiotics + EN group,prebiotics+EN group and EN group(P＞0.05).2,Plasm diamine oxidase(DAO):Plasm DAO of probiotics + EN group and synbiotics + EN group is lower than EN group(P＜0.05).Although the levels of endotoxin were lowered in prebiotics+EN group compared with EN group,there are no differences between them(P＞0.05).3,The level of serum tumor necrosis factor -a(TNF-α):The results showed that the level of TNF-αin probiotics + EN group were lower,significantly than EN group (P＜0.05);the level of prebiotics+EN group was lower than EN but no significantly differences.4,The level of serum inflammatory cytokines IL-6:The level of serum IL-6 decreased significantly in probiotics + EN group compared with EN group and prebiotics+EN group(P＜0.05).The levels of IL-6 were lowered in synbiotics + EN and prebiotics+EN group compared with EN group,but there are no differences between them(P＞0.05).5,Mucosal thickness and villous height:The level of mucosal thickness and villous height were higher in probiotics + EN group compared with EN group and prebiotics+EN group(P＜0.05);moreover the condition of synbiotics + EN group is better than EN group(P＜0.05 )6,Results of intestinal morphologic study:It has obviously inflammatory reanction in intestinal mucosa,and the necrosis and abscission of villus is less.The morphous of intestinal villi is approximately integrity,some villus become blunting,while gland of lamina propria is abundant.The condition of synbiotics + EN group is much better than EN group.There are little change have been found between prebiotics+EN group and control group.Conclusion:probiotics and EN can improve the intestinal tract microenvironment of SAP rat,reduce pathogenic bacterium,and protect the function of intestinal barrier; while oatβ-glucan with EN dose not improve the intestinal barrier function.Part Three The effect of microecology supplement with enterai nutrition on intestinal transfer and absorption of rats with severe acute pancretitis.Objective:To investigate the influences of probiotics,prebiotics and synbiotics supplement with enteral nutrition on the intestinal transfer and absorption of rats with severe acute pancretitis.Method:Thirty Sprague-Dawley(SD) model rats of severe acute pancretitis, which had be administerated with enteral nutrition plus with prebiotics or probiotics 7 days were divided into five groups:EN group(1),prebiotics+EN group(2), probiotics + EN group(3),synbiotics + EN group(4) and control group(5) via jejunostomy.The nutrition support in the four groups was isonitrogen and isocaloric. Before sacrifice on the seventh day,gastrointestinal transfer and D -xylose absorption test was performed and vein blood was tested for MTL;Specimens of jejunum were obtained to measure the ATPase activity.Result:1,Gut transfer function:gat transfer index decreased significantly in every SAP group;the level in probiotics + EN group was higher than prebiotics+EN group;there were no significant different between probiotics + EN and EN group;prebiotics+EN group and synbiotics +EN groups decreased compared with EN group,but there are no differences between them(P＞0.05)2,Serum D-xylose:The results showed that the level of serum D-xylose in model group were lower than other group,(P＜0.05);the level in probiotics + EN group and synbiotics +EN group was significantly higher than prebiotics+EN group and EN group (P＜0.05);prebiotics+EN group was lower than EN but no significantly differences.3,Gastrointestinal tissue ATPase activity.The quantity of ATP enzyme in gastrointestinal tissue decrease mostly in model group than other group,(P＜0.05);the level of Na+-K+-ATPase,Ca2+-ATPase in probiotics + EN group was higher significantly than EN group and prebiotics+EN group(P＜0.05),that of Mg2+-ATPase,Ca2+-Mg2+-ATPase was also higher significantly than prebiotics+EN group(P＜0.05); the quantity of ATP enzyme in EN group was higher and prebiotics+EN group was lower than others,but here are no differences between them(P＜0.05).4,Serum MTL:The level of serum MTL in model group were lower than EN and probiotics + EN group(P＜0.05);compared with EN group and prebiotics+EN group, the level of serum MTL was significantly higher in probiotics + EN groups(P＜0.05); there are no differences between synbiotics +EN group,prebiotics+EN group and EN groups(P＞0.05).Conclusion:So probiotics and EN can enhance the function of small intestinal peristalsis of SAP rat by promoting secretion of motilin,and promote the absorption function of SAP rat;while oatβ-glucan with EN dose not improve the above function of SAP rat.