Schricker Thomas, Wykes Linda, Carvalho George, Mazza Louise, Eberhart Leopold, Carli Franco, Meterissian Sarkis
Department of Anesthesia, McGill University Montreal, Royal Victoria Hospital, Montreal, Quebec, Canada H3A 1A1.
Metabolism. 2007 Nov;56(11):1508-13. doi: 10.1016/j.metabol.2007.06.017.
We tested the hypothesis that perioperative amino acid supplementation of hypocaloric dextrose would attenuate the inhibitory effect of glucose on endogenous glucose production after surgery. Sixteen patients undergoing colorectal cancer surgery were randomly assigned to receive intravenous glucose either with or without amino acids. Nutrition was administered over 48 hours from surgical skin incision until the second postoperative day. Glucose provided 50% and amino acids 20% of the patient's measured resting energy expenditure. Glucose rate of appearance was assessed by [6,6-2H2]glucose before and after surgery. Circulating concentrations of glucose, lactate, insulin, and glucagon were also determined. Hypocaloric glucose suppressed postoperative endogenous glucose production to a similar degree in both groups. The circulating concentrations of glucose increased to the same extent, whereas there was no significant change in plasma concentrations of lactate, glucagon, and cortisol. Postoperative plasma levels of insulin were significantly higher in patients receiving amino acids (P = .009). Perioperative amino acid administration does not mitigate the inhibitory effect of glucose on glucose production or aggravate hyperglycemia after colorectal surgery.
围手术期补充氨基酸的低热量葡萄糖会减弱葡萄糖对术后内源性葡萄糖生成的抑制作用。16例接受结直肠癌手术的患者被随机分配接受含或不含氨基酸的静脉葡萄糖。从手术皮肤切口至术后第二天的48小时内给予营养支持。葡萄糖提供患者测得静息能量消耗的50%，氨基酸提供20%。手术前后通过[6,6-2H2]葡萄糖评估葡萄糖的出现率。还测定了葡萄糖、乳酸、胰岛素和胰高血糖素的循环浓度。两组中低热量葡萄糖对术后内源性葡萄糖生成的抑制程度相似。葡萄糖的循环浓度升高程度相同，而乳酸、胰高血糖素和皮质醇的血浆浓度无显著变化。接受氨基酸治疗的患者术后血浆胰岛素水平显著更高（P = 0.009）。围手术期给予氨基酸并不能减轻葡萄糖对葡萄糖生成的抑制作用，也不会加重结直肠癌手术后的高血糖。
