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肠外给予氨基酸对比葡萄糖输注:一种合成代谢策略,用于最小化 2 型糖尿病患者手术时的分解代谢反应,同时维持正常血糖。

Parenteral amino acids v. dextrose infusion: an anabolic strategy to minimise the catabolic response to surgery while maintaining normoglycaemia in diabetes mellitus type 2 patients.

机构信息

Department of Anaesthesia, McGill University, Montreal, Canada.

出版信息

Br J Nutr. 2012 Feb;107(4):573-80. doi: 10.1017/S0007114511003126. Epub 2011 Aug 17.

Abstract

Loss of body protein and hyperglycaemia represent typical features of the stress response to surgery and anaesthesia. This appears to be particularly pronounced in patients with diabetes mellitus type 2. The aim of the present study was to highlight the greater benefit of amino acids (AA) as represented by positive protein balance and maintenance of blood glucose homoeostasis compared with dextrose (DEX) in diabetic patients after colorectal surgery. A total of thirteen patients underwent a 5 h stable isotope infusion study (2 h fasted, 3 h fed with an infusion of AA (n 6) or DEX (n 7)) on the second post-operative day. Glucose and protein kinetics were assessed by using the stable isotopes l-[1-¹³C]leucine and [6,6-²H₂]glucose. The transition from fasted to fed state decreased endogenous glucose production (P < 0·001) in both groups, with a more profound effect in the DEX group (P = 0·031). In contrast, total glucose production was increased by the provision of DEX while being lowered by AA (P = 0·021). Feeding decreased protein oxidation (P = 0·009) and protein synthesis in the AA group, whereas DEX infusion did not affect oxidation and even decreased protein synthesis. Therefore, only AA shifted protein balance to a positive value, while patients in the DEX group remained in a catabolic state (P < 0·001). Parenteral nutritional support with AA rather than with DEX is an effective strategy to achieve a positive protein balance while maintaining normoglycaemia in diabetic patients after colorectal surgery.

摘要

机体蛋白质丢失和高血糖是手术和麻醉应激反应的典型特征。2 型糖尿病患者的这种反应似乎更为明显。本研究旨在强调氨基酸(AA)相对于葡萄糖(DEX)的更大益处,即在结直肠手术后的糖尿病患者中,AA 可实现正蛋白平衡和维持血糖稳态。共有 13 例患者在术后第 2 天接受了 5 h 的稳定同位素输注研究(禁食 2 h,输注 AA(n 6)或 DEX(n 7)3 h)。通过使用稳定同位素 l-[1-¹³C]亮氨酸和[6,6-²H₂]葡萄糖评估葡萄糖和蛋白质动力学。从禁食到进食状态的转变降低了两组的内源性葡萄糖生成(P < 0·001),DEX 组的影响更明显(P = 0·031)。相反,DEX 的供给增加了总葡萄糖生成,而 AA 降低了总葡萄糖生成(P = 0·021)。喂养降低了 AA 组的蛋白质氧化(P = 0·009)和蛋白质合成,而 DEX 输注则不影响氧化,甚至降低了蛋白质合成。因此,只有 AA 使蛋白质平衡转为正值,而 DEX 组的患者仍处于分解代谢状态(P < 0·001)。与 DEX 相比,AA 而非 DEX 的肠外营养支持是一种有效的策略,可以在结直肠手术后的糖尿病患者中实现正蛋白平衡并维持正常血糖。

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