Schricker Thomas, Meterissian Sarkis, Donatelli Francesco, Carvalho George, Mazza Louise, Eberhart Leopold, Wykes Linda, Carli Franco
Department of Anesthesia, McGill University Montreal, Canada H3A 1A1.
Metabolism. 2007 Aug;56(8):1044-50. doi: 10.1016/j.metabol.2007.03.013.
Although capable of inducing an anabolic state after surgery, parenteral nutrition, including glucose, leads to hyperglycemia. Even moderate increases in blood glucose are associated with poor surgical outcome. We examined the hypothesis that amino acids, in the absence of glucose supply, spare protein while preventing hyperglycemia. In this prospective study, 14 patients with colonic cancer were randomly assigned to undergo a 6-hour stable isotope infusion study (3 hours of fasting followed by 3-hour infusions of amino acids, Travasol [Baxter, Montreal, Canada] 10% at 0.02 mL.kg(-1).min(-1), with or without glucose at 4 mg.kg(-1).min(-1)) on the second day after colorectal surgery. Protein breakdown, protein oxidation, protein balance, and glucose production were assessed by stable isotope tracer kinetics using l-[1-(13)C]leucine and [6,6-(2)H2]glucose. Circulating concentrations of glucose, cortisol, insulin, and glucagon were determined. The administration of amino acids increased protein balance from -16+/-4 micromol.kg(-1).h(-1) in the fasted state to 16+/-3 micromol.kg(-1).h(-1). Combined infusion of amino acids and glucose increased protein balance from -17+/-7 to 7+/-5 micromol.kg(-1).h(-1). The increase in protein balance during nutrition was comparable in the 2 groups (P=.07). Combined administration of amino acids and glucose decreased endogenous glucose production (P=.001) and stimulated insulin secretion (P=.001) to a greater extent than the administration of amino acids alone. Hyperglycemia (blood glucose, 10.1+/-1.9 micromol/L) occurred only in the presence of glucose infusion. In summary, excluding glucose from a short-term feeding protocol does not diminish the protein-sparing effect of amino acids and avoids hyperglycemia.
尽管肠外营养（包括葡萄糖）能够在术后诱导合成代谢状态，但会导致高血糖。即使血糖出现中度升高也与手术预后不良相关。我们检验了这样一个假设：在不供应葡萄糖的情况下，氨基酸可节省蛋白质同时预防高血糖。在这项前瞻性研究中，14例结肠癌患者在结直肠手术后第二天被随机分配接受一项为期6小时的稳定同位素输注研究（禁食3小时，随后以0.02 mL·kg⁻¹·min⁻¹的速度输注10%的氨基酸溶液特拉伐索尔[百特公司，加拿大蒙特利尔]3小时，输注过程中或添加或不添加4 mg·kg⁻¹·min⁻¹的葡萄糖）。通过使用l-[1-(¹³)C]亮氨酸和[6,6-(²)H₂]葡萄糖的稳定同位素示踪动力学来评估蛋白质分解、蛋白质氧化、蛋白质平衡和葡萄糖生成。测定葡萄糖、皮质醇、胰岛素和胰高血糖素的循环浓度。氨基酸输注使蛋白质平衡从禁食状态下的-16±4 μmol·kg⁻¹·h⁻¹增加至16±3 μmol·kg⁻¹·h⁻¹。氨基酸和葡萄糖联合输注使蛋白质平衡从-17±7增加至7±5 μmol·kg⁻¹·h⁻¹。两组在营养期间蛋白质平衡的增加幅度相当（P = 0.07）。与单独输注氨基酸相比，氨基酸和葡萄糖联合给药在更大程度上降低了内源性葡萄糖生成（P = 0.001）并刺激了胰岛素分泌（P = 0.001）。高血糖（血糖，10.1±1.9 μmol/L）仅在输注葡萄糖时出现。总之，在短期喂养方案中不使用葡萄糖不会减弱氨基酸的蛋白质节省作用，并且可避免高血糖。
