Erken enteral ve glutaminli enteral beslenmenin kolon anastomoz iyileşmesine etkisi: Deneysel çalışma
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Dosyalar
Tarih
2006
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ Ameliyat sonrası total enteral beslenmenin (TEB) erken uygulanmasının ve beslenmeye glutamin eklenmesinin deneysel kolon anastomoz iyileşmesine etkisi araştırıldı.
GEREÇ VE YÖNTEM Çalışmada 40 Wistar-albino sıçan eşit sayıda denek içeren 4 gruba ayrıldı. Deneklere distal sol kolon transseksiyonu ve anastomozu uygulandı. Grup 1 ve 2’ye geç TEB; grup 3 ve 4’e erken TEB uygulandı. Grup 2 ve 4’te beslenmeye glutamin eklendi. Ameliyat sonrası yedinci günün sonunda anastomoz içeren kolon segmenti çıkarılarak anastomoz patlama basıncı ve doku hidroksiprolin değerleri belirlendi.
BULGULAR Anastomoz patlama basıncı erken grupta 111.6, geç grupta 95.8 cmH2O bulundu (p=0.022). Geç TEB grupları arasında glutaminli grup lehine anlamlı fark saptandı (95.8’e 138.5 cmH2O; p<0.0001). Gerek erken, gerekse geç glutaminli TEB’in uygulandığı gruplarda en yüksek patlama basıncı değerleri elde edildi (139 ve 138.5 cmH2O). Doku hidroksiprolin miktarı, erken (2440.3 µg) ve geç (1509.6 µg) TEB grupları arasında anlamlı farklı bulundu (p=0.024). Geç enteral beslenme grupları karşılaştırıldığında glutaminli grup lehine anlamlı olmamakla (p=0.276) birlikte sayısal fark saptandı (1509.6 ya 1981.6 µg).
SONUÇ Ameliyat sonrası dönemde TEB’in erken uygulanması anastomoz direnci ve kollajen sentezini anlamlı olarak desteklemektedir. Anastomoz direnci açısından geç TEB uygulandığı durumda beslenmeye glutamin eklenmesi, geç beslenme olumsuzluklarını azaltmakta ve geri döndürmektedir. Glutaminin benzer olumlu etkisi daha zayıf olmakla birlikte kollajen sentezi üzerinde de görülmektedir.
BACKGROUND To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH2O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH2O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH2O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 µg) was significantly higher than late TEN group (1509.6 µg; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 µg). CONCLUSION Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.
BACKGROUND To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis. METHODS Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined. RESULTS Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH2O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH2O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH2O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 µg) was significantly higher than late TEN group (1509.6 µg; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 µg). CONCLUSION Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.
Açıklama
Anahtar Kelimeler
Anastomoz, Cerrahi, Kolon/Cerrahi, Enteral Beslenme, Glutamin, Hidroksiprolin, Parenteral Beslenme, Ameliyat Sonrası Bakım/Metot, Sıçan, Wistar Cinsi, Yara İyileşmesi, Anastomosis, Surgical, Colon/Surgery, Enteral Nutrition, Glutamine, Hydroxyproline, Parenteral Nutrition, Postoperative Care/Methods, Rats, Wistar, Wound Healing
Kaynak
Ulusal Travma Dergisi
Ulusal Travma ve Acil Cerrahi Dergisi
Turkish Journal of Trauma and Emergency Surgery
Ulusal Travma ve Acil Cerrahi Dergisi
Turkish Journal of Trauma and Emergency Surgery
WoS Q Değeri
Scopus Q Değeri
Q2
Cilt
12
Sayı
1
