Nordenström J, Jeevanandam M, Elwyn D H, Carpentier Y A, Askanazi J, Robin A, Kinney J M
Clin Physiol. 1981 Oct;1(5):525-34. doi: 10.1111/j.1475-097x.1981.tb00919.x.
Total Parenteral Nutrition (TPN) was given to 15 traumatized or infected patients with all of the non-protein calories, either as intravenous glucose (Glucose System), or as 50% glucose + 50% intravenous fat (Lipid System). Before the administration of TPN, mean urinary excretion of unconjugated norepinephrine was 2.37 +/- 0.52 (SEM) microgram/kg/day, which is significantly higher than for normal subjects (0.62 +/- 0.04 microgram/kg/day; n = 56). TPN with the Glucose System for 4-6 days significantly increased the norepinephrine excretion from 1.95 +/- 0.47 to 6.77 +/- 0.95 microgram/kg/day (P less than 0.01). When TPN with the Lipid System was given the increase (from 3.05 +/- 0.89 to 4.26 +/- 0.70 microgram/kg/day) was not statistically significant. A modest increase in resting energy expenditure was seen with the Glucose System but not with the Lipid System. The administration of high glucose loads during TPN, in addition to providing nutritional support, may exert a metabolic stress as reflected by increased metabolic rate and increased catecholamine excretion. These metabolic changes are reduced when intravenous fat emulsions are substituted for a major part of glucose calories.
对15例创伤或感染患者给予全胃肠外营养（TPN），非蛋白热量全部通过静脉输注葡萄糖（葡萄糖组）或50%葡萄糖+50%静脉脂肪乳（脂质组）提供。在给予TPN之前，未结合去甲肾上腺素的平均尿排泄量为2.37±0.52（标准误）微克/千克/天，显著高于正常受试者（0.62±0.04微克/千克/天；n = 56）。葡萄糖组给予TPN 4 - 6天可使去甲肾上腺素排泄量从1.95±0.47显著增加至6.77±0.95微克/千克/天（P<0.01）。给予脂质组TPN时，去甲肾上腺素排泄量增加（从3.05±0.89至4.26±0.70微克/千克/天）无统计学意义。葡萄糖组静息能量消耗有适度增加，而脂质组未出现。TPN期间给予高糖负荷，除提供营养支持外，可能会引发代谢应激，表现为代谢率增加和儿茶酚胺排泄增加。当静脉脂肪乳替代大部分葡萄糖热量时，这些代谢变化会减轻。
