Carli Franco, Galeone Marina, Gzodzic Branca, Hong Xi, Fried Gerald M, Wykes Linda, Eberhart Leopold, Schricker Thomas
Department of Anesthesia, School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada.
Arch Surg. 2005 Jun;140(6):593-7. doi: 10.1001/archsurg.140.6.593.
Using a stable isotope method to quantify postoperative changes in glucose and protein metabolism, patients undergoing laparoscopic-assisted colon resection and receiving 4 mg . kg(-1) . min(-1) of dextrose intravenously will (1) have more pronounced suppression of endogenous glucose production, leading to (2) a greater reduction in whole-body protein breakdown.
Randomized protocol study.
Tertiary health care center in Montreal, Quebec.
Twelve patients scheduled for colonic resection were randomly allocated to undergo either laparoscopic (n = 6) or open (n = 6) surgery.
Patients underwent a 6-hour stable isotope infusion study (3 hours fasted and 3 hours fed with dextrose infusion) on postoperative day 2. Whole-body protein breakdown and synthesis, amino acid oxidation, and endogenous glucose production and clearance were measured during the postabsorptive state using L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose. Gas exchange and plasma concentrations of metabolites and hormones were also measured.
Endogenous glucose production and whole-body protein breakdown during the fasted and fed states.
In the fasted state, laparoscopy did not affect protein and glucose metabolism. Dextrose infusion suppressed endogenous glucose production in both groups, with the greatest extent in the laparoscopic group (P = .01). Higher respiratory quotients (P = .001) in the latter group also indicated increased exogenous glucose oxidation. Neither surgical approach nor nutrition affected aspects of protein metabolism.
Laparoscopy for colon resection facilitates whole-body glucose uptake and utilization and oxidation of exogenous glucose with no protein-sparing effect. The laparoscopic approach modulates gluconeogenesis, although it is not sufficient in the presence of exogenous energy to promote nitrogen retention.
采用稳定同位素法量化术后葡萄糖和蛋白质代谢变化，接受腹腔镜辅助结肠切除术并静脉输注4mg·kg⁻¹·min⁻¹葡萄糖的患者将：（1）内源性葡萄糖生成受到更显著抑制，进而（2）全身蛋白质分解减少幅度更大。
随机方案研究。
魁北克省蒙特利尔的三级医疗保健中心。
12例计划行结肠切除术的患者被随机分配接受腹腔镜手术（n = 6）或开放手术（n = 6）。
患者在术后第2天接受为期6小时的稳定同位素输注研究（禁食3小时，输注葡萄糖喂养3小时）。在吸收后状态下，使用L-[1-(¹³)C]亮氨酸和[6,6-(²)H₂]葡萄糖测量全身蛋白质分解与合成、氨基酸氧化以及内源性葡萄糖生成与清除。还测量了气体交换以及代谢物和激素的血浆浓度。
禁食和喂养状态下的内源性葡萄糖生成及全身蛋白质分解。
在禁食状态下，腹腔镜手术不影响蛋白质和葡萄糖代谢。葡萄糖输注抑制了两组的内源性葡萄糖生成，在腹腔镜组抑制程度最大（P = 0.01）。后一组较高的呼吸商（P = 0.001）也表明外源性葡萄糖氧化增加。手术方式和营养均未影响蛋白质代谢方面。
腹腔镜结肠切除术有利于全身葡萄糖摄取、利用以及外源性葡萄糖氧化，且无蛋白质节省效应。腹腔镜手术方式可调节糖异生，尽管在有外源性能量存在时不足以促进氮潴留。
