Role of Gut after severe surgical stress
Grant-in-Aid for Scientific Research (C)
|Allocation Type||Single-year Grants|
|Research Institution||Teikyo University|
FUKUSHIMA Ryoji Department of Surgery II Teikyo University School of Medicine, Lecturer, 医学部, 講師 (50228897)
IINUMA Hisae Department of Surgery II Teikyo University School of Medicine, Assistant, 医学部, 助手 (30147102)
KOBAYASHI Satoshi Department of Surgery II Teikyo University School of Medicine, Assistant
|Project Period (FY)
1997 – 1999
Completed(Fiscal Year 1999)
|Budget Amount *help
¥3,600,000 (Direct Cost : ¥3,600,000)
Fiscal Year 1999 : ¥700,000 (Direct Cost : ¥700,000)
Fiscal Year 1998 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 1997 : ¥2,300,000 (Direct Cost : ¥2,300,000)
|Keywords||Bacterial Translocation / Cytokines / MSOF / second attack theory / early enteral nutrition / laparotomy / 早期経腸栄養 / 完全静脈栄養 / 経腸栄養|
Sepsis that follows severe trauma often results in multiple system organ failure (MSOF) and death. The sequential nature of this clinical picture has led to the idea of a "two-hit" or "second attack" theory for the development of MSOF. We investigated bacterial translocation (BT) and cytokine responses in a rat second attack model and see if the timing and route of nutrition supply can modulate these responses.
Methods: Rats (n=57) underwent midline laparotomy and were postoperatively challenged I.p. with zymosan as a second attack. Animals were divided into S1 (zymozan on POD1) and S3 (zymozan on POD3) group and each group of rats were further divided into TPN (total parenteral nutrition) group, TEN (total enteral nutrition) group and C (chow) group. After laparotomy TPN and TEN rats received isocaloric and isonitrogenous nutrition. Rats in C group were provided standard rat chow ad libitum. Eighteen hours after zymosan challenge, rats were gavaged with 108 E. coli and sacr
ificed four hours later. Liver, mesenteric lymphnode (MLN), spleen and blood were harvested. BT and cytokine levels in the organs were determined.
Early occurrence of postoperative second attack (S1) resulted in higher incidence of bacterial translocation and u regulated IL-6 response than in the late occurrence of second attack (S2), Nutrition supply by enteral route decreased translocation of bacterial and IL-6 production.
Conclusion: Nutrition supply by enteral route appeared to be most useful in the early postoperative course when the occurrence of second attack may cause serious consequences.
On the basis of experiment I, post operative early enteral nutrition was performed to those underwent total gastrectomy or subtotal esophagectomy. Enteral nutrition was initiated in 26 patients within 24 hours after surgery. In the initial 12 patients, 300 kcal/day was administered on POD 1 and 2, 600 kcal/day on POD 3 and 4, 1200 kcal/day after POD 5. Enteral nutrition was discontinued in two patients on POD 4 and the amount was decreased in two patients on POD 5 because of abdominal distention and/or diarrhea. In the rest of patients, 900 kcal/day was administered after POD 5 and they were well tolerated.
It is concluded that early enteral nutrition within 24 hours post gastrointestinal surgery was possible in the majority of patients. Less
Research Output (3results)