Just B, Messing B, Darmaun D, Rongier M, Camillo E
Nutrition Unit, Saint-Lazare Hospital, Paris, France.
Am J Clin Nutr. 1990 Jan;51(1):107-11. doi: 10.1093/ajcn/51.1.107.
Five male adult home patients were studied in a randomized order under continuous (24 h/d) and nocturnal cyclic (15 h/d) isocaloric, isonitrogenous total parenteral nutrition (TPN). They received 2626 +/- 265 total kcal/d as 60% dextrose and 40% lipids; the 3-h lipid infusion was followed by the dextrose amino acid infusion on both regimens. Substrate oxidation was measured by indirect calorimetry during four periods on the fourth day of each regimen. During cyclic TPN net lipogenesis occurred with a nonproteic respiratory quotient (npRQ) greater than 1 during dextrose amino acid infusion followed by net lipolysis with an npRQ less than 1 during the nonnourishing phase. In contrast, during continuous TPN net lipogenesis persisted with an npRQ greater than 1 over the 21 h of dextrose amino acid infusion. During the 3-h lipid infusion, fat oxidation was observed during both regimens but was more pronounced during cyclic TPN (p less than 0.05). As a consequence, 24-h lipid oxidation was higher and 24-h dextrose utilization lower during cyclic vs continuous TPN (p less than 0.05). These results suggest that cyclic TPN when alternating between substrate storage and oxidation, mimics the physiological pattern of oral feeding.
对5名成年男性居家患者按照随机顺序进行了研究，他们接受持续（每天24小时）和夜间循环（每天15小时）的等热量、等氮量的全胃肠外营养（TPN）。他们每天摄入2626±265千卡的热量，其中60%为葡萄糖，40%为脂肪；在两种方案中，3小时的脂肪输注后接着输注葡萄糖氨基酸。在每种方案的第四天的四个时间段内，通过间接测热法测量底物氧化情况。在循环TPN期间，在葡萄糖氨基酸输注期间非蛋白呼吸商（npRQ）大于1时发生净脂肪生成，随后在非营养阶段npRQ小于1时发生净脂肪分解。相比之下，在持续TPN期间，在葡萄糖氨基酸输注的21小时内，npRQ大于1时净脂肪生成持续存在。在3小时的脂肪输注期间，两种方案均观察到脂肪氧化，但在循环TPN期间更明显（p<0.05）。因此，与持续TPN相比，循环TPN期间24小时脂肪氧化更高，24小时葡萄糖利用率更低（p<0.05）。这些结果表明，循环TPN在底物储存和氧化之间交替时，模拟了口服喂养的生理模式。
