Wilmore D W
Clin Endocrinol Metab. 1976 Nov;5(3):731-45. doi: 10.1016/s0300-595x(76)80048-5.
During the initial shock or 'ebb' phase of injury, body glucose (serum glucose concentration X glucose space) is significantly increased but mass flow to peripheral tissue is only slightly altered. During the 'flow' or hypermetabolic phase of injury, mass flow of glucose is markedly increased, related to the extent of injury and directed primarily by increased sympathetic nervous system activity. Increased hepatic gluconeogenesis provides glucose which is converted to three-carbon precursors in the periphery and returns to the liver for reconversion to new glucose, utilising the Cori and alanine cycles. Increased ureagenesis is a consequence of skeletal muscle amino acids contributing to this cycle system. This energy shuttle system produces heat, and the rate of six- to three-carbon cycling correlates closely with the increased oxygen consumption of the injured patient. The glucose cycle may be altered by hormonal administration, food intake, exercise, weight loss, pharmacological manipulation and infection, but the basic reset in hepatic glucose production and energy demands in the injured patient appears essential for the inflammatory response and tissue repair.
在损伤的初始休克或“潮落”阶段，机体葡萄糖（血清葡萄糖浓度×葡萄糖分布容积）显著增加，但向周围组织的物质流量仅略有改变。在损伤的“流动”或高代谢阶段，葡萄糖的物质流量显著增加，与损伤程度相关，主要由交感神经系统活动增加所驱动。肝脏糖异生增加提供葡萄糖，葡萄糖在外周转化为三碳前体，然后回到肝脏再转化为新的葡萄糖，利用科里循环和丙氨酸循环。尿素生成增加是骨骼肌氨基酸参与该循环系统的结果。这种能量穿梭系统产生热量，六碳到三碳的循环速率与受伤患者增加的耗氧量密切相关。葡萄糖循环可能会因激素给药、食物摄入、运动、体重减轻、药物操作和感染而改变，但受伤患者肝脏葡萄糖生成和能量需求的基本重置似乎对炎症反应和组织修复至关重要。
