Schricker T, Wykes L, Eberhart L, Carli F, Meterissian S
Department of Anaesthesia, Montreal, Quebec, Canada.
Br J Surg. 2005 Aug;92(8):947-53. doi: 10.1002/bjs.5105.
The observed failure of hypocaloric nutrition to establish an anabolic state after surgery may reflect inadequate control for the type and quality of analgesia in the studies performed. This study was designed to test the hypothesis that hypocaloric nutrition induces anabolism in patients who receive effective segmental pain relief using perioperative epidural analgesia.
Sixteen patients who underwent colorectal surgery and received epidural analgesia were randomly assigned to receive intravenous glucose either without (glucose only) or with amino acids (nutrition). Feeding was administered over 48 h from surgical skin incision until the second day after operation. Glucose provided 50 per cent of the patient's resting energy expenditure (REE). Amino acids were infused at rates that provided 20 per cent of REE. Leucine rate of appearance (Ra), leucine oxidation and non-oxidative leucine disposal (NOLD) were assessed by measuring L-[1-13C]leucine kinetics. A positive leucine balance, that is the difference between NOLD and leucine Ra, indicated anabolism.
After surgery, leucine Ra in the nutrition group was lower than that in the glucose only group (mean(s.d.) 88(25) versus 131(22) micromol per kg per h). The leucine balance remained negative in the glucose only group, whereas it became positive in the nutrition group (mean(s.d.) -24(3) versus 38(12) micromol per kg per h; P < 0.001).
Patients who receive hypocaloric parenteral nutrition can be rendered anabolic after colorectal surgery in the presence of epidural analgesia.
在已开展的研究中，术后低热量营养未能建立合成代谢状态，这可能反映出镇痛类型和质量的控制不足。本研究旨在验证以下假设：对于接受围手术期硬膜外镇痛以有效缓解节段性疼痛的患者，低热量营养可诱导合成代谢。
16例行结直肠手术并接受硬膜外镇痛的患者被随机分配，分别接受不含氨基酸的静脉葡萄糖输注（仅葡萄糖组）或含氨基酸的静脉葡萄糖输注（营养组）。从手术皮肤切口开始，持续48小时给予输注，直至术后第二天。葡萄糖提供患者静息能量消耗（REE）的50%。氨基酸以提供REE 20%的速率输注。通过测量L-[1-13C]亮氨酸动力学评估亮氨酸的出现率（Ra）、亮氨酸氧化和非氧化亮氨酸处置（NOLD）。正的亮氨酸平衡，即NOLD与亮氨酸Ra之间的差值，表明存在合成代谢。
术后，营养组的亮氨酸Ra低于仅葡萄糖组（均值（标准差）：88（25）对131（22）微摩尔/千克/小时）。仅葡萄糖组的亮氨酸平衡仍为负，而营养组的亮氨酸平衡变为正（均值（标准差）：-24（3）对38（12）微摩尔/千克/小时；P<0.001）。
在硬膜外镇痛的情况下，接受低热量肠外营养的患者在结直肠手术后可实现合成代谢。
