Erken enteral ve gl�taminli enteral beslenme kolon anastomoz iyile�mesini desteklemektedir

G�KPINAR, �brahim; G�RLEY�K, Emin; PEHL�VAN, Mevlut; �ZCAN, �mer; �ZAYDIN, �smet; ASLANER, Arif; DEM�RARAN, Yavuz; G�LTEPE, Mustafa

Cilt : 12 Say� : 1 Y�l : 2024

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Erken enteral ve gl�taminli enteral beslenme kolon anastomoz iyile�mesini desteklemektedir [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2006; 12(1): 17-21

Erken enteral ve gl�taminli enteral beslenme kolon anastomoz iyile�mesini desteklemektedir

�brahim G�KPINAR¹, Emin G�RLEY�K¹, Mevlut PEHL�VAN¹, �mer �ZCAN², �smet �ZAYDIN¹, Arif ASLANER¹, Yavuz DEM�RARAN³, Mustafa G�LTEPE²
¹Abant �zzet Baysal �niversitesi, D�zce T�p Fak�ltesi, Genel Cerrahi AD. D�zce.
²G�lhane Askeri T�p Akademisi, Biyokimya AD. Haydarpa�a, �stanbul.
³Abant �zzet Baysal �niversitesi, D�zce T�p Fak�ltesi, Anestezi ve Reanimasyon AD. D�zce.

AMA�: Postoperatif d�nemde total enteral beslenmenin erken uygulanmas� ve beslenme protokol�ne gl�tamin eklenmesinin deneysel kolon anastomoz iyile�mesine etkisini ara�t�rmak.
GERE�-Y�NTEM: 40 Wistar-albino rat e�it say�da denek i�eren 4 gruba ayr�ld�. T�m deneklere distal sol kolon transseksiyonu ve anastomozu uyguland�. Grup 1 ve 2; ge� total enteral beslenme (postoperatif 4. g�nden itibaren) uyguland�. Grup 3 ve 4; erken total enteral beslenme (postoperatif 6. saatten itibaren) uyguland�. Grup 2 (ge�) ve 4 (erken)�te enteral beslenme protokol�ne gl�tamin eklendi. Postoperatif 7. g�n sonunda anastomoz i�eren kolon segmenti ��kar�larak anastomoz patlama bas�nc� ve doku hidroksiprolin de�erleri belirlendi.
BULGULAR: Anastomoz patlama bas�nc� de�erleri erken grupta 111.6, ge� grupta 95.8 cm/su (p=0.022) bulundu. Ge� enteral beslenme gruplar� (1 ve 2) kar��la�t�r�ld��nda gl�taminli grup lehine anlaml� fark (95.8� e 138.5 cm/su; p<0.0001) saptand�. Gerek erken, gerekse ge� d�nemde gl�taminli enteral beslenmenin uyguland�� gruplarda en y�ksek patlama bas�nc� de�erleri (139 ve 138.5 cm/su) elde edildi.
Doku hidroksiprolin miktar� erken beslenme grubunda (2440.3 �g), ge� beslenme grubuna (1509.6 �g)
g�re anlaml� y�ksek (p=0.024) bulundu. Di�er gruplar aras� farklar istatistik a��s�ndan anlams�zd�. Ge� enteral beslenme gruplar� (1 ve 2) kar��la�t�r�ld��nda gl�taminli grup lehine anlaml� olmamakla (p=0.276) birlikte say�sal fark (1509.6 ya 1981.6 �g) saptand�.
SONU�LAR: Postoperatif d�nemde total enteral beslenmenin erken uygulanmas� anastomoz direnci ve kollajen sentezini anlaml� olarak desteklemektedir. Anastomoz direnci a��s�ndan enteral yolun ge� kullan�ld�� durumda beslenme protokol�ne gl�tamin eklenmesi, ge� beslenme olumsuzluklar�n� azaltmakta ve geri d�nd�rmektedir. Gl�taminin benzer olumlu etkisi daha zay�f olmakla birlikte kollajen sentezi �zerinde de g�r�lmektedir.
Anahtar Kelimeler: Kolon anastomozu, enteral beslenme, gl�tamin, patlama bas�nc�, hidroksiprolin.

Anahtar Kelimeler: Anahtar Kelimeler: Kolon anastomozu, enteral beslenme, gl�tamin, patlama bas�nc�, hidroksiprolin.

Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis

�brahim G�KPINAR¹, Emin G�RLEY�K¹, Mevlut PEHL�VAN¹, �mer �ZCAN², �smet �ZAYDIN¹, Arif ASLANER¹, Yavuz DEM�RARAN³, Mustafa G�LTEPE²
¹Department of Surgery, Abant Izzet Baysal University, Duzce Medical Faculty, Duzce, Turkey
²Department of Biochemistry, G�lhane Military Medical Academy, Haydarpa�a, Istanbul, Turkey.
³Department of Anaestesia and Reanimation, Abant Izzet Baysal University, Duzce Medical Faculty, Duzce, Turkey

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 distal left colon was performed on all animals. Groups 1 and 2; Animals received late (after 4th day postoperatively) enteral feeding. Groups 3 and 4; Animals received early (after 6th hours postoperatively) enteral feeding. Glutamine was added in enteral nutrition protocol in groups 2 (late) and 4 (early). The colonic segment including the anastomosis was excised at the end of 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined.
RESULTS: Bursting pressures levels were measured as 111.6 and 95.8 cm/water (p=0.022) in early and late nutrition groups respectively. Comparison of late enteral feeding groups (1 and 2) showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cm/water; p<0.0001). Highest bursting pressure levels (139 and 138.5 cm/water) were measured in both early and late feeding groups with glutamine.
Tissue hydroxyproline level in early enteral feeding group (2440.3 �g) was significantly (p=0.024) higher than late enteral feeding group (1509.6 �g). The differences were not statistically significant between other groups. Comparison of late enteral feeding groups (1 and 2) showed a considerable difference in favor of group with glutamine (1509.6 vs 1981.6 �g) but not statistically significant (p=0.276).
CONCLUSION: Postoperative early enteral feeding significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses disadvantages of late enteral feeding in point of the resistance of anastomosis. Similar positive and useful, but weaker effects of glutamine supplementation are also valuables on collagen synthesis

Keywords: Key Words: Colonic anastomosis, enteral feeding, glutamine, bursting pressure, hydroxyproline.

Sorumlu Yazar: Emin G�RLEY�K, T�rkiye
Makale Dili: T�rk�e

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