Yunis K A, Oh W
Brown University Program in Medicine, Women and Infants' Hospital of Rhode Island, Providence 02905-2499.
J Pediatr. 1989 Jul;115(1):127-32. doi: 10.1016/s0022-3476(89)80347-6.
To determine the effects of intravenous glucose loading on basal oxygen consumption, resting energy expenditure, and basal carbon dioxide production in infants with bronchopulmonary dysplasia who were still oxygen dependent, we administered intravenous glucose loads of 4 and 12 mg/kg-1/min-1 on 2 consecutive days, under identical experimental conditions, to six infants with bronchopulmonary dysplasia and six healthy control subjects. Infants were not fed for 9 hours before and during the 4- to 6-hour study periods; the intravenous glucose infusion, along with an amino acid mixture (2 gm.kg-1.24 hr-1), was started at the beginning of the fasting period. Oxygen consumption and carbon dioxide production and resting energy expenditure were measured by a flow-through indirect calorimetry technique under basal conditions. Infants with oxygen-dependent bronchopulmonary dysplasia had significantly higher basal oxygen consumption and resting energy expenditure than did control infants and significantly higher basal carbon dioxide production during the high glucose infusion. With glucose loading, infants with bronchopulmonary dysplasia had a significant rise in basal oxygen consumption (7.91 +/- 0.91 ml.kg-1.min-1 to 9.65 +/- 1.35 ml.kg-1.min-1, p less than 0.05), basal carbon dioxide production (5.93 +/- 0.72 ml.kg-1.min-1 to 7.10 +/- 1.04 ml.kg-1.min-1), and resting energy expenditure (53.8 +/- 5.75 kcal.kg-1.24 hr-1 to 65.3 +/- 7.0 kcal.kg-1.24 hr-1, all p values less than 0.05). Control infants had no significant changes with intravenous glucose loading. We conclude that intravenous glucose loading in infants with bronchopulmonary dysplasia resulted in a net increase in resting energy expenditure, which should be taken into account in assessing their energy intake during nutritional management. The risk of pulmonary stress caused by an increase in basal oxygen consumption and carbon dioxide production resulting from glucose load should also be considered.
为了确定静脉输注葡萄糖负荷对仍依赖氧气的支气管肺发育不良婴儿的基础氧耗量、静息能量消耗和基础二氧化碳生成的影响，我们在相同的实验条件下，连续两天对6例支气管肺发育不良婴儿和6例健康对照受试者静脉输注4和12mg/kg-1/min-1的葡萄糖负荷。在4至6小时的研究期间之前和期间，婴儿禁食9小时；在禁食期开始时开始静脉输注葡萄糖，并同时输注氨基酸混合物（2g.kg-1.24hr-1）。通过流通式间接测热技术在基础条件下测量氧耗量、二氧化碳生成量和静息能量消耗。依赖氧气的支气管肺发育不良婴儿的基础氧耗量和静息能量消耗显著高于对照婴儿，在高葡萄糖输注期间基础二氧化碳生成量也显著更高。葡萄糖负荷时，支气管肺发育不良婴儿的基础氧耗量（从7.91±0.91ml.kg-1.min-1升至9.65±1.35ml.kg-1.min-1，p<0.05）、基础二氧化碳生成量（从5.93±0.72ml.kg-1.min-1升至7.10±1.04ml.kg-1.min-1）和静息能量消耗（从53.8±5.75kcal.kg-1.24hr-1升至65.3±7.0kcal.kg-1.24hr-1，所有p值均<0.05）均显著升高。对照婴儿静脉输注葡萄糖负荷后无显著变化。我们得出结论，支气管肺发育不良婴儿静脉输注葡萄糖负荷导致静息能量消耗净增加，在营养管理评估其能量摄入时应予以考虑。还应考虑葡萄糖负荷导致基础氧耗量和二氧化碳生成量增加所引起的肺部应激风险。
