Bacterial Translocation Relationship with Enteral L-Glutamine and L-Alanine in Experimental Rat Burn Model

Objective: The aim of this experimental study is to research the effects of L-alanine and L-glutamine, which are being widely used on intensive care patients, on the liver, structural changes in the small intestine, wound healing, and bacterial translocation. Method: Twenty male Sprague Dawley rats which weighe 190-230 gr were used in this study. Rats were separated into two randomized groups. In accordance with experimental rat burn model, skin burn was created in every rat and both groups were fed equally for 21 days. The experimental group was administered L-glutamine + L-alanine containing product (Dipeptiven®, Fresenius Kabi BadHamborg, Germany) for 5 mL/kg/day orally. At the end of the 21st day, all rats were sacrificed. Biopsy materials were obtained from the liver, small intestine, and burn wound, and blood culture was taken under sterile conditions. In pathologic examination, structural changes in tissues and wound healing were evaluated. In microbiologic examination, the effects of L-glutamine and L-alanine on bacterial translocation were evaluated by comparing small intestine and blood cultures. Results: No structural difference was seen among small intestine biopsies between two groups. No liver damage was seen in the experimental group while live biopsies showed grade 1 damage in the control group. Epithelization and granulation were detected as better in the pathologic examination of skin biopsies obtained from burn wound in the experimental group. Microbiologic examination showed bacterial replication in a total of 4 rats from the control group, two rats showed replication of S. aures in the small intestine and blood culture and two rats showed replication of S. epidermidis in the small intestine and blood culture. No replication was determined in any rats from the experimental group. Conclusion: In the light of findings acquired from this study done with experimental rat burn model, we think that the use of L-glutamine + L-alanine will have positive effects on wound healing and help preventing the bacterial translocation in burn patients as a supporting product.

Deneysel Sıçan Yanık Modelinde, Enteral L-Glutamin ve L-Alanin ile Bakteriyel Translokasyon İlişkisi

Amaç: Bu deneysel çalışmanın amacı, yoğun bakım hastalarında sıklıkla kullanılan L-alanin + L-glutaminin, karaciğer, ince bağırsaktaki yapısal değişikliklere, yara iyileşmesine ve bakteriyel translokasyona etkilerinin araştırılmasıdır. Yöntem: Bu çalışmada 190-230 gr olan 20 adet erkek Sprague Dawley rat kullanıldı. Deney, 2 grup üzerinde tasarlandı. Tüm ratlarda, deneysel rat yanık modeline uygun olarak yanık oluşturuldu ve her iki grup eşit şartlarda 21 gün beslendi. Deney grubuna, 5 mL/kg/gün L-glutamin + L-alanin içeren (Dipeptiven®, Fresenius Kabi BadHamborg, Almanya) preparat oral yolla verildi. Yirmi bir günün sonunda tüm ratlar sakrifiye edildi. Tüm ratlardan steril şartlarda, karaciğer, ince bağırsak, yanık yarasından biyopsiler ve kan kültürleri alındı. Patolojik incelemede karaciğer ve ince bağırsak dokularındaki yapısal değişiklikler ve yara iyileşmesi değerlendirildi. Mikrobiyolojik incelemede ince bağırsak ve kan kültürleri kıyaslanarak L- glutamin + L-alaninin bakteriyel translokasyona etkisi araştırıldı. Bulgular: İki grup arasında ince bağırsak biyopsileri arasında hiçbir yapısal fark görülmedi. Karaciğer biyopsilerinde kontrol grubunda grade 1 hasarlanma mevcutken deney grubunda hasar tespit edilemedi. Yanık yarasından alınan deri biyopsilerinin patolojik incelemesinde deney grubunda epitelizasyon ve granulasyonun daha iyi olduğu tespit edildi. Mikrobiyolojik incelemede kontrol grubundaki iki ratın ince bağırsak ve kan kültürlerinde S. aureus, iki ratın ince bağırsak ve kan kültürlerinde de S.epidermidis olmak üzere toplamda dört ratta üreme tespit edildi.Deney grubundaki hiçbir ratın ince bağırsak ve kan kültürlerinde üreme olmadı. Sonuç: Deneysel rat yanık modelinde yapılan bu çalışmanın sonucunda elde ettiğimiz verilere göre, L-glutamin + L-alanin kullanımının, yanık hastalarının yara iyileşmesine olumlu etkisi olduğu, ek olarak da bakteriyel translokasyonu engellemeye yardımcı olduğu kanısına vardık.

Kaynakça

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