Delalande J P, Le Page J L, Le Bos-Monnot M, Perramant M, Egreteau J P
Ann Fr Anesth Reanim. 1984;3(6):414-20. doi: 10.1016/s0750-7658(84)80137-9.
Twenty-seven non emaciated patients undergoing major visceral surgery were randomly divided into two different groups according to the postoperative parenteral diet (100% glucose versus 50% fat 50% glucose). All patients received the same anaesthetic protocol and, peroperatively, none received any glucose. In the postoperative phase, parenteral feeding was started on the day of operation (18.5-21.8 kcal X kg-1) and was continued for a minimum of four days (37-44 kcal X kg-1 X 24 h-1). All patients received intravenous insulin and phosphorus (0.15 mmol X kg-1 X 24 h-1). During five days, daily measurements of serum phosphate and glucose levels were made and nitrogen balance was studied. For all these parameters, there was no evidence of any significant difference between the two groups. A significant fall in plasma phosphate occurred in each group on the first postoperative day, was maximum on the second and lasted until the fourth. This fall was not influenced by parenteral diet. No patients in this study developed symptoms of phosphate depletion. The glucose levels increased significantly and the nitrogen sparing effect was similar in both groups. The mechanism of hypophosphataemia seemed to be an intracellular transfer under the influence of hyperglycaemia and high plasma insulin levels rather than an increase in urinary phosphate excretion. The advantage of using lipid solutions did not appear under the dietary conditions studied. Indeed a glucose supply greater than or equal to 3 mg X kg-1 X min-1 seemed to induce a maximum intracellular transfer of phosphorus. Because of this, phosphate supplementation and frequent measurement of serum phosphate are recommended for patients undergoing major visceral surgery and postoperative intravenous feeding.
27例接受大型内脏手术的非消瘦患者根据术后肠外营养饮食（100%葡萄糖与50%脂肪+50%葡萄糖）被随机分为两组。所有患者均接受相同的麻醉方案，且术中均未接受任何葡萄糖。术后阶段，于手术当日开始肠外营养（18.5 - 21.8千卡×千克⁻¹），并持续至少4天（37 - 44千卡×千克⁻¹×24小时⁻¹）。所有患者均接受静脉胰岛素和磷（0.15毫摩尔×千克⁻¹×24小时⁻¹）。在五天时间里，每日测量血清磷酸盐和葡萄糖水平，并研究氮平衡。对于所有这些参数，两组之间均未发现任何显著差异。每组患者术后第一天血浆磷酸盐均显著下降，第二天降至最低，并持续至第四天。这种下降不受肠外营养饮食的影响。本研究中没有患者出现磷酸盐耗竭症状。两组患者的葡萄糖水平均显著升高，且氮节省效应相似。低磷血症的机制似乎是在高血糖和高血浆胰岛素水平影响下的细胞内转移，而非尿磷酸盐排泄增加。在所研究的饮食条件下，使用脂质溶液的优势并未显现。实际上，葡萄糖供应大于或等于3毫克×千克⁻¹×分钟⁻¹似乎会诱导最大程度的细胞内磷转移。因此，对于接受大型内脏手术和术后静脉营养的患者，建议补充磷酸盐并频繁测量血清磷酸盐。
