Ono K, Wakamatsu M, Katoh H, Furuta M, Kondoh U, Kasamatsu M, Okumura Y
Department of Anesthesia, Chubu Rosai Hospital, Nagoya.
Masui. 1993 May;42(5):707-12.
We have measured blood concentrations of glucose, 3-hydroxybutyrate (3-OHBA), non-esterified fatty acid (NEFA) and lactate before and after glucose administration in 105 patients to determine the optimal glucose dose during the period of preoperative fasting state. The patients, scheduled for laparotomy in the afternoon, received fluid infusion containing an arbitrary glucose dose for 4 hours prior to surgery. The glucose dose showed a negative correlation with the ratio of 3-OHBA or NEFA prior to and after glucose administration (r = 0.40, r = 0.41 respectively, P < 0.05). There was no correlation between lactate ratio and glucose dose (r = 0.06). Glucose administration more than 0.4 g.kg-1 significantly suppressed 3-OHBA production (P < 0.05). Hyperglycemia (> 200 mg.dl-1) developed more often in the groups given 0.5 g.kg-1 or more glucose (P < 0.05), while significant hypoglycemia (< 60 mg.dl-1) occurred in the groups given less than 0.2 g.kg-1 of glucose (P < 0.05). This study demonstrates that preoperative infusion of glucose 0.4-0.5 g.kg-1 is useful to maintain the energy metabolism during the fasting state in patients scheduled for operation in the afternoon.
我们测定了105例患者在给予葡萄糖前后的血糖、3-羟基丁酸（3-OHBA）、非酯化脂肪酸（NEFA）和乳酸的血浓度，以确定术前禁食状态期间的最佳葡萄糖剂量。计划在下午进行剖腹手术的患者在手术前4小时接受含有任意葡萄糖剂量的液体输注。葡萄糖剂量与给予葡萄糖前后的3-OHBA或NEFA的比值呈负相关（分别为r = 0.40，r = 0.41，P < 0.05）。乳酸比值与葡萄糖剂量之间无相关性（r = 0.06）。给予超过0.4 g·kg-1的葡萄糖可显著抑制3-OHBA的产生（P < 0.05）。给予0.5 g·kg-1或更多葡萄糖的组中高血糖（> 200 mg·dl-1）更常发生（P < 0.05），而给予少于0.2 g·kg-1葡萄糖的组中发生显著低血糖（< 60 mg·dl-1）（P < 0.05）。本研究表明，术前输注0.4 - 0.5 g·kg-1的葡萄糖有助于维持计划下午手术患者禁食状态期间的能量代谢。
