Haider W, Benzer H, Coraim F, Khosropour R, Mohl W, Müller M
Anaesthesist. 1981 Feb;30(2):53-63.
Immediately after open heart operations (extracorporeal circulation) 22 patients were investigated in 2 groups at the intensive care unit. Whereas the control group received Ringer lactate as postoperative infusion (RL-group), the 2nd group was given 50% glucose (0.5 g/kg/h) and insulin (250 U/1,000 cc) (GI-group). In case of need (blood glucose level) additional insulin up to 200 U/h, maximum 800 U/10 h, was supplied. On the 1st postoperative day 500 ml 10% crystalline amino acid solution was added. Before the start of postoperative infusion therapy postoperative serum insulin levels were low in spite of considerably elevated blood glucose levels (glucose utilisation disorder, insulin suppression). In contrast with the RL-group there was in the GI-group a significant decrease of FFA-serum level and cAMP serum level which developed during the infusion. Urine output and urinary glucose excretion was nearly equal in both groups. Urinary potassium excretion in the GI-group remained significantly one third lower than that of the RL-group, in spite of the potassium supply to the GI-group being nearly twice and serum potassium level approximately equal. Urinary sodium excretion of GI-group on the other hand was approximately 15% higher than that of RL-group. In relation to preoperative values postoperative urinary N-excretion of the GI-group was unchanged, whereas in RL-group the postoperative N-excretion was significantly 30% increased; in postoperative alpha-amino-N-excretion there was only a small difference between the groups, which indicates an insulin-modifiable increase in protein breakdown rather than a decreased protein synthesis. According to the obviously improved situation in energetic considerations, cell membrane potential restoration and N-balance resp. protein synthesis in the insulin treated group, the question is discussed whether this therapy (APA) which shifts metabolism to an anabolic state, is of a certain value as a therapeutic measure in the postshock phase.
在心脏直视手术（体外循环）后，立即在重症监护病房对22例患者进行了两组研究。对照组术后输注乳酸林格液（RL组），第二组给予50%葡萄糖（0.5 g/kg/h）和胰岛素（250 U/1000 cc）（GI组）。如有需要（根据血糖水平），额外补充胰岛素，最高可达200 U/h，最大剂量为800 U/10 h。术后第1天加入500 ml 10%的结晶氨基酸溶液。尽管血糖水平显著升高（葡萄糖利用障碍，胰岛素抑制），但术后输注治疗开始前，术后血清胰岛素水平较低。与RL组相比，GI组在输注过程中FFA血清水平和cAMP血清水平显著降低。两组尿量和尿糖排泄量几乎相等。尽管GI组的钾供应量几乎是RL组的两倍且血清钾水平大致相同，但GI组的尿钾排泄量仍显著低于RL组三分之一。另一方面，GI组的尿钠排泄量比RL组高约15%。与术前值相比，GI组术后尿氮排泄量未变，而RL组术后氮排泄量显著增加30%；两组术后α-氨基氮排泄量仅有微小差异，这表明胰岛素可调节蛋白质分解增加，而非蛋白质合成减少。根据能量代谢、细胞膜电位恢复和氮平衡及蛋白质合成方面明显改善的情况，讨论了这种将代谢转变为合成代谢状态的治疗方法（APA）在休克后阶段作为一种治疗措施是否具有一定价值。
