Aärimaa M, Syvälahti E, Viikari J, Ovaska J
Acta Chir Scand. 1978;144(7-8):411-22.
Six patients subjected to major surgery (esophageal resection, group I) and eight patients undergoing moderate surgery (exploratory laparotomy, group II) were investigated in order to study the effects of surgery and glucose infusion on the blood glucose, plasma FFA, serum insulin and growth hormone concentrations as well as on the urinary excretion of adrenaline, noradrenaline and nitrogen. In the patients undergoing esophageal resection, blood samples were taken at short intervals during five 24-hour periods, covering a time span from the second preoperative to the tenth postoperative day. In the case of exploratory laparotomy four such periods up to fifth postoperative day were similarly investigated. For adrenaline, noradrenaline and nitrogen, urine was collected in two 12-hour samples for each 24-hour period in order to roughly estimate the "day" and "night" excretions. The results and conclusions can be summarized as follows: A rapid rise in blood glucose and plasma FFA concentrations occurred after the beginning surgery. The zeniths of the curves were recorded about 4--6 hours after the skin incision in both patient groups, despite the different duration of the operations. This suggests that the regulatory mechanism is spontaneously active for a certain time after being initially triggered. Insulin secretion was usually suppressed 4--5 hours after the beginning of surgery. A marked increase of insulin secretion occurred after this time, the rise of IRI being associated with a fall of BG and FFA. Maximum insulin secretion was recorded during the night after surgery. Because excretion of noradrenaline was maximal during this time in group I, noradrenaline activity is perhaps a less likely explanation of the suppression of insulin. The response of growth hormone secretion to surgery and anesthesia was not uniform. Trauma apparently causes no constant rise, whereas a rather regular elevation of serum GH levels follows the fall in BG and plasma FFA concentrations, In group I there was a decrease of insulin and GH secretion and the number of insulin and GH "peaks" in the postoperative period, possibly reflecting a weakening of central stimuli after major surgery. The same was not always noted in group II, in which the mean secretion of insulin was postoperatively somewhat elevated compared to the preoperative values. Urine analyses revealed no day--night rhythmicity in catecholamine excretion except possibly on the day of operation, when the "day" samples contained absolutely and proportionately more adrenaline than the "night" samples.
为研究手术和葡萄糖输注对血糖、血浆游离脂肪酸（FFA）、血清胰岛素和生长激素浓度以及肾上腺素、去甲肾上腺素和氮的尿排泄量的影响，对6例接受大手术（食管切除术，I组）和8例接受中等手术（剖腹探查术，II组）的患者进行了调查。在接受食管切除术的患者中，在五个24小时期间内每隔短时间采集血样，时间跨度从术前第二天到术后第十天。对于剖腹探查术，同样对术后第五天内的四个这样的时间段进行了调查。对于肾上腺素、去甲肾上腺素和氮，在每个24小时期间收集两个12小时的尿样，以便大致估计“白天”和“夜间”的排泄量。结果和结论可总结如下：手术开始后血糖和血浆FFA浓度迅速升高。尽管手术持续时间不同，但两组患者在皮肤切口后约4 - 6小时记录到曲线的峰值。这表明调节机制在最初触发后会在一定时间内自发活跃。胰岛素分泌通常在手术开始后4 - 5小时受到抑制。此后胰岛素分泌显著增加，胰岛素释放指数（IRI）的升高与血糖（BG）和FFA的下降相关。术后夜间记录到最大胰岛素分泌。由于I组在此期间去甲肾上腺素排泄量最大，去甲肾上腺素活性可能不太可能是胰岛素抑制的原因。生长激素分泌对手术和麻醉的反应并不一致。创伤显然不会导致持续升高，而血清GH水平相当规律的升高是在BG和血浆FFA浓度下降之后出现的。在I组中，术后胰岛素和GH分泌减少，胰岛素和GH“峰值”数量减少，这可能反映了大手术后中枢刺激的减弱。II组并非总是如此，II组术后胰岛素平均分泌量与术前值相比有所升高。尿液分析显示，除了可能在手术当天，儿茶酚胺排泄没有昼夜节律，此时“白天”样本中的肾上腺素绝对含量和比例均高于“夜间”样本。
