Piccone V A, LeVeen H H, Glass P, Berlyne G, Lundin A P
Surgery. 1980 Mar;87(3):263-70.
A technique for prehepatic infusion of parenteral nutrients is described. Portal vein hyperalimentation allows hepatic modification and control of the infused nutrients before delivery of these substances into the general circulation and theoretically should reduce the incidence of metabolic complications of hyperalimentation. The clinical experience with prehepatic infusions is reported and the metabolic investigations are described. Transumbilical catheters provided prehepatic delivery of parenteral nutrients for 1 month after esophagogastrectomy for esophageal malignancy without serious infection or portal vein thrombosis. Close surveillance of blood glucose and serum osmolarity demonstrated metabolic stability during the infusion period. Nitrogen balance studies showed better nitrogen economy than is achieved by infusion of similar solutions into the central systemic circulation. Indirect calorimetry indicated that the nitrogen used for production of energy was less than the amount supplied by prehepatic infusions. The same basic liver function abnormalities encountered with systemic infusion of hyperalimentation solutions were noted. The patients gained weight after esophagogastrectomy and did not experience the attrition from malnutrition which usually occurs in the first several months after esophageal resection.
本文描述了一种肝前肠外营养输注技术。门静脉高营养可使输注的营养物质在进入体循环之前得到肝脏的调节和控制，理论上应能降低高营养代谢并发症的发生率。报告了肝前输注的临床经验并描述了代谢研究情况。经脐导管在食管恶性肿瘤行食管胃切除术后为患者提供了1个月的肝前肠外营养输注，未发生严重感染或门静脉血栓形成。对血糖和血清渗透压的密切监测显示输注期间代谢稳定。氮平衡研究表明，与通过向体循环中心输注类似溶液相比，氮的利用率更高。间接测热法表明，用于产生能量的氮量少于肝前输注所提供的氮量。同时也注意到与全身输注高营养溶液时相同的基本肝功能异常情况。食管胃切除术后患者体重增加，未出现食管切除术后最初几个月通常会出现的营养不良所致的消瘦。
