Postshock Intervention With High-Lipid Enteral Nutrition Reduces Inflammation and Tissue Damage

被引:46
作者
de Haan, Jacco-Juri [1 ]
Lubbers, Tim [1 ]
Hadfoune, M'hamed [1 ]
Luyer, Misha D. [2 ]
Dejong, Cornelis H. [1 ]
Buurman, Wim A. [1 ]
Greve, Jan-Willem M. [1 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Surg, NUTRIM, NL-6200 MD Maastricht, Netherlands
[2] Maasland Hosp, Dept Surg, Sittard, Netherlands
关键词
D O I
10.1097/SLA.0b013e318188752c
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To investigate the effects of high-lipid enteral nutrition in a setting of developing inflammation and tissue damage. Background: An excessive inflammatory response following severe trauma is associated with poor clinical outcome. Currently, therapies directed at attenuation of an ongoing inflammatory cascade are lacking. Administration of high-lipid enteral nutrition before hemorrhagic shock has been shown to effectively inhibit early and late proinflammatory cytokines by activation of the autonomic nervous system via cholecystokinin (CCK)-receptors. Methods: A rat model of hemorrhagic shock was used in which animals were either fasted or treated with higb-lipid or control low-lipid enteral nutrition. CCK-receptor antagonists were administered before feeding. Tissues and plasma were collected to assess inflammation and intestinal integrity. Results: Administration of high-lipid enteral nutrition after shock reduced plasma interferon-gamma (IFN-gamma) significantly in comparison with those in low-lipid-treated and fasted animals (P < 0.01 and P < 0.001, respectively). Also, interleukin (IL)-10 levels in plasma were decreased in comparison with those in fasted animals (P < 0.001). Enterocyte damage, expressed as circulating ileal lipid-binding protein (ILBP), was prevented by early high-lipid nutrition in comparison with that in low-lipid-treated and fasted animals (P = 0.05 and P < 0.001, respectively). Furthermore, high-lipid feeding preserved intestinal integrity in comparison with that observed in low-lipid-treated and fasted annuals, as assessed by bacterial translocation (BT) to distant organs (P < 0.05 and P < 0.001, respectively) and ileal permeability to horseradish peroxidase (HRP) (P = 0.05 and P < 0.001, respectively). The protective effects of high-lipid intervention were nullified by CCK-receptor antagonists (IFN-gamma; IL-10; BT; and HRP; P < 0.05). Conclusion: High-lipid enteral nutrition given postshock reduces inflammation and preserves tissue integrity via a CCK-receptor-dependent mechanism. These findings implicate that intervention with high-lipid enteral nutrition following events such as severe trauma is a potential therapy to attenuate the developing inflammatory response.
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页码:842 / 848
页数:7
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