Svensson S, Svedjeholm R, Ekroth R, Milocco I, Nilsson F, Sabel K G, William-Olsson G
Department of Thoracic and Cardiovascular Surgery, Sahlgrenska Hospital, Göteborg, Sweden.
J Thorac Cardiovasc Surg. 1990 Jun;99(6):1063-73.
In a controlled, randomized study the myocardial uptake/release of individual free fatty acids, glucose, lactate, pyruvate, alanine, and glycerol was studied 1 hour after completion of coronary operations. The effects of insulin were evaluated by means of a hyperinsulinemic "clamp" technique. No significant uptake of free fatty acids was found despite markedly elevated arterial concentrations (mean +/- standard error of the mean, 2.01 +/- 0.19 mmol.L-1), oleic acid, together with palmitic and linoleic acid, constituting 80% of the total plasma free fatty acid level. Insulin treatment (1 unit.kg bw-1.hr-1) prevented a further increase of the plasma free fatty acid level, observed concomitantly in the control group. Insulin affected all individual free fatty acids similarly. Changes in plasma free fatty acid levels occurring during the study and the corresponding myocardial uptake correlated (rS = 0.50 to 0.81). No significant uptake or release of glucose, lactate pyruvate, and glycerol occurred, whereas a myocardial release of alanine was seen. The heart and the concomitant leg uptake/release of glucose (rS = 0.40, p less than 0.05) and lactate (rS = 0.67, p less than 0.01) correlated. A substantial uptake of glucose was achieved and a more positive myocardial balance was obtained for alanine, lactate, and pyruvate with insulin. The changes in heart and the concomitant leg uptake/release correlated (glucose, rS = 0.62, p less than 0.01; lactate, rS = 0.64, p less than 0.01; pyruvate, rS = 0.71, p less than 0.01). It is concluded that the myocardial uptake of substrates during the first hours after coronary surgery is markedly abnormal with no uptake of free fatty acids or carbohydrates. These changes can be explained to some extent by the insulin resistance of trauma metabolism and can be modified by insulin treatment.
在一项对照随机研究中，在冠状动脉手术完成1小时后，对个体游离脂肪酸、葡萄糖、乳酸、丙酮酸、丙氨酸和甘油的心肌摄取/释放情况进行了研究。通过高胰岛素“钳夹”技术评估胰岛素的作用。尽管动脉浓度显著升高（均值±均值标准误差，2.01±0.19 mmol·L⁻¹），但未发现游离脂肪酸有明显摄取，油酸与棕榈酸和亚油酸一起占血浆游离脂肪酸总量的80%。胰岛素治疗（1单位·kg体重⁻¹·小时⁻¹）可防止对照组中同时观察到的血浆游离脂肪酸水平进一步升高。胰岛素对所有个体游离脂肪酸的影响相似。研究期间血浆游离脂肪酸水平的变化与相应的心肌摄取相关（rS = 0.50至0.81）。未发生葡萄糖、乳酸、丙酮酸和甘油的明显摄取或释放，而观察到心肌有丙氨酸释放。心脏与同时腿部对葡萄糖（rS = 0.40，p < 0.05）和乳酸（rS = 0.
