人体前臂和腿部的灌注技术所提供的代谢信息并不相同。

The forearm and leg perfusion techniques in man do not give the same metabolic information.

作者信息

Möller-Loswick A C, Bennegård K, Lundholm K

机构信息

Department of Anestesiology, University of Gothenburg, Sweden.

出版信息

Clin Physiol. 1991 Jul;11(4):385-95. doi: 10.1111/j.1475-097x.1991.tb00667.x.

DOI:10.1111/j.1475-097x.1991.tb00667.x

PMID:1914441

Abstract

The present study evaluates whether forearm and leg perfusion techniques give the same metabolic information. Seven patients hospitalized for operation of uncomplicated disease were investigated pre-operatively in the fasted state, while seven other patients who were on intravenous nutrition were studied in the fed state. Blood flow and the extremity exchange of glucose, lactate, glycerol, free fatty acids and amino acids were measured simultaneously across the forearm and the leg in all individuals. In the fasted state the arteriovenous difference (a-v) of glucose uptake was statistically significant across the forearm while it was statistically insignificant across the leg (0.27 +/- 0.06 vs. -0.04 +/- 0.13 mmol l-1). The a-v differences of glycerol (0.025 +/- 0.028 vs. -0.043 +/- 0.013 mmol l-1) and free fatty acids 0.10 +/- 0.03 vs. -0.10 +/- 0.04 mmol l-1) were positive across the forearm while they were negative across the leg (P less than 0.01). In the fasted state the a-v difference of oxygen uptake (3.93 +/- 0.67 vs. 3.21 +/- 0.44 mmol l-1) and blood flow (4.1 +/- 1.0 vs. 4.0 +/- 0.7 ml min-1 100 g-1) did not differ between the arm and the leg, but the a-v difference in carbon dioxide production was significantly higher (P less than 0.05) across the forearm (2.43 +/- 0.37 vs. 1.29 +/- 0.29 mmol l-1) compared to the leg. In the fed state all the above-mentioned differences between forearm and leg became statistically insignificant. In the fed state the a-v difference of the sum of all amino acids was not significantly different from zero balance across the forearm (-146 +/- 103 mmol l-1) while there was a significant release from the leg (-175 +/- 6 mmol l-1, P less than 0.05). In the fed state the flux of the sum of all amino acids became significantly positive across the arm while it was not significantly different from zero balance across the leg. In the fed state, forearm blood flow was significantly higher than leg blood flow (6.2 +/- 0.5 vs. 4.0 +/- 0.2 ml min-1 100 g-1, P less than 0.001). The results in the present study demonstrate that the metabolic balance across regions of peripheral tissues may simultaneously differ considerably, i.e. being positive across the forearm and negative across the leg. This fact may imply that some previous claims may need reconsideration about 'peripheral tissue metabolism' associated with a certain clinical condition.

摘要

本研究评估前臂和腿部灌注技术是否能提供相同的代谢信息。对7例因单纯疾病住院手术的患者在禁食状态下进行术前研究，同时对7例接受静脉营养的患者在进食状态下进行研究。在所有个体中，同时测量前臂和腿部的血流以及葡萄糖、乳酸、甘油、游离脂肪酸和氨基酸的肢体交换情况。在禁食状态下，前臂葡萄糖摄取的动静脉差值具有统计学意义，而腿部则无统计学意义（0.27±0.06 vs. -0.04±0.13 mmol·l⁻¹）。甘油（0.025±0.028 vs. -0.043±0.013 mmol·l⁻¹）和游离脂肪酸（0.10±0.03 vs. -0.10±0.04 mmol·l⁻¹）的动静脉差值在前臂为正值，而在腿部为负值（P＜0.01）。在禁食状态下，手臂和腿部的氧摄取动静脉差值（3.93±0.67 vs. 3.21±0.44 mmol·l⁻¹）和血流（4.1±1.0 vs. 4.0±0.7 ml·min⁻¹·100 g⁻¹）无差异，但前臂的二氧化碳产生动静脉差值显著高于腿部（P＜0.05）（2.43±0.37 vs. 1.29±0.29 mmol·l⁻¹）。在进食状态下，前臂和腿部之间上述所有差异均无统计学意义。在进食状态下，前臂所有氨基酸总和的动静脉差值与零平衡无显著差异（-146±103 mmol·l⁻¹），而腿部有显著释放（-175±6 mmol·l⁻¹，P＜0.05）。在进食状态下，所有氨基酸总和的通量在前臂显著为正，而在腿部与零平衡无显著差异。在进食状态下，前臂血流显著高于腿部血流（6.2±0.5 vs. 4.0±0.2 ml·min⁻¹·100 g⁻¹，P＜0.001）。本研究结果表明，外周组织区域间的代谢平衡可能同时存在相当大的差异，即在前臂为正而在腿部为负。这一事实可能意味着，一些先前关于与特定临床状况相关的“外周组织代谢”的说法可能需要重新考虑。