Förster H, Dudziak R, Steuer A, Boecker S
Infusionsther Klin Ernahr. 1976 Aug;3(4):228-35.
Influence of the infusion of amino acid solutions on metabolic changes caused by parenteral nutrition with fructose. In eleven unconscious polytraumatized patients of the intensive care station, intravenous infusions with fructose (0.5 g/kg bodyweight and hour) were performed. During the last 24 hours of the 72 hours infusion period, amino acid solutions (1.0 g/kg bodyweight and 24 hours) were given in addition to fructose. The investigations were initiated after an eight hour "starvation period" preinfusion. During this time only electrolytes were given. For comparison 48 hours intravenous infusions with fructose (0.5 g/kg B.W. and hour) were performed with six healthy volunteers. In both groups of subjects the intravenous fructose was metabolized very well, renal losses were less than 2% of the whole amount given. Considering the metabolic healthy volunteers, the blood glucose concentration remained unaltered despite the high dosage carbohydrate infusion. The patients of the intensive care station showed a slight increase of blood glucose values which were elevated already before infusion. Additionally, during fructose infusions, the increase in blood lactate concentration was more pronounced in the intensive care patients than in healthy volunteers. However, in contrast to the healthy volunteers, no increase in serum bilirubin concentration and only a slight increase in serum uric acid concentration was observed in the intensive care patients, despite the high-dose fructose infusion for 72 hours. Additionally, the fructose-induced hypertriglyceridemia was of a minor degree in the intensive care patients. In volunteers the increase in triglyceride concentration was 200% in 48 hours, whereas only a 50% increase was observed in intensive care patients during 72 hours. The pronounced nitrogen sparing effect of fructose in healthy volunteers was not seen in the intensive care patients to the same degree. The most prominent side effect of the fructose infusions in intensive care patients was the strong decrease in serum phosphate concentration seen in some patients. The additional infusion of amino acid solutions lead to a further diminution of the slight alterations caused by fructose infusions. In conclusion, it can be stated that total parenteral nutrition with fructose and amino acid solutions is possible in intensive care patients without danger of side effects. However, it should be mnetioned that hyperalimentation can cause fatty liver.
氨基酸溶液输注对果糖肠外营养所致代谢变化的影响。在重症监护站的11名昏迷多发伤患者中，进行了果糖静脉输注（0.5 g/kg体重·小时）。在72小时输注期的最后24小时，除果糖外还给予了氨基酸溶液（1.0 g/kg体重·24小时）。在8小时的输注前“饥饿期”后开始进行研究。在此期间仅给予电解质。作为对照，对6名健康志愿者进行了48小时的果糖静脉输注（0.5 g/kg体重·小时）。在两组受试者中，静脉输注的果糖代谢良好，肾脏损失少于给予总量的2%。就代谢情况而言，尽管给予了高剂量的碳水化合物输注，但健康志愿者的血糖浓度保持不变。重症监护站的患者血糖值略有升高，在输注前就已升高。此外，在果糖输注期间，重症监护患者血乳酸浓度的升高比健康志愿者更为明显。然而，与健康志愿者不同，尽管进行了72小时的高剂量果糖输注，但重症监护患者的血清胆红素浓度没有升高，血清尿酸浓度仅略有升高。此外，果糖诱导的高甘油三酯血症在重症监护患者中程度较轻。在志愿者中，甘油三酯浓度在48小时内升高了200%，而在重症监护患者中，72小时内仅升高了50%。果糖在健康志愿者中显著的氮节约效应在重症监护患者中未达到相同程度。重症监护患者果糖输注最突出的副作用是部分患者血清磷酸盐浓度明显降低。氨基酸溶液的额外输注导致果糖输注引起的轻微改变进一步减轻。总之，可以说在重症监护患者中进行果糖和氨基酸溶液的全肠外营养是可能的，且无副作用风险。然而，应该提到的是，高营养支持可能会导致脂肪肝。
