Murakawa T, Satoh Y, Kudo M, Kudo T, Matsuki A
Department of Anesthesiology, Odate Municipal Hospital.
Masui. 1995 Nov;44(11):1506-12.
The authors measured arterial plasma levels of acetoacetate, 3-hydroxybutyrate, free fatty acid and the blood levels of lactate and glucose to evaluate fat metabolism during isoflurane anesthesia and surgery in twenty patients who ranged in age from 17 to 67 years. They underwent non-abdominal surgery (orthopedic surgery) or abdominal surgery (gastrointestinal or gynecological surgery). The operation started at 9 AM following starvation after 9 PM of the day before surgery. Anesthesia was induced with intravenous thiopental followed by intravenous succinylcholine to facilitate tracheal intubation, and maintained with isoflurane in 50 % nitrous oxide and 50 % oxygen. Vecuronium was given intravenously during surgery. Lactated Ringer's solution at a speed of 5-15 ml.kg-1.h-1 was also administered intravenously throughout the procedures. Patients who had received glucose solution or blood transfusion were excluded. Plasma acetoacetate and 3-hydroxybutyrate levels increased significantly with surgical stimulation in both groups and they were slightly higher in the abdominal group than those in the non-abdominal group. However there was no statistical difference in plasma keton body levels between the groups. Mild increases in plasma free fatty acid and blood lactate levels were detected during surgery in both groups to the same extent. Blood glucose increased significantly during surgery in both groups and the increase was statistically higher in the abdominal group than that in the non-abdominal group. The findings suggest that there is no difference in fat metabolism between non-abdominal and abdominal groups during surgical intervention lasting as long as 3 hours when patients are starved and do not receive any glucose during surgery.
作者测定了20例年龄在17至67岁之间患者在异氟烷麻醉和手术期间动脉血浆中乙酰乙酸、3-羟基丁酸、游离脂肪酸的水平以及血液中乳酸和葡萄糖的水平，以评估脂肪代谢情况。这些患者接受了非腹部手术（骨科手术）或腹部手术（胃肠或妇科手术）。手术于手术前一天晚上9点禁食后次日上午9点开始。静脉注射硫喷妥钠诱导麻醉，随后静脉注射琥珀酰胆碱以利于气管插管，并用异氟烷在50%氧化亚氮和50%氧气中维持麻醉。手术期间静脉注射维库溴铵。整个手术过程中还以5-15 ml.kg-1.h-1的速度静脉输注乳酸林格氏液。接受过葡萄糖溶液或输血的患者被排除在外。两组患者的血浆乙酰乙酸和3-羟基丁酸水平在手术刺激下均显著升高，且腹部手术组略高于非腹部手术组。然而，两组间血浆酮体水平无统计学差异。两组患者在手术期间血浆游离脂肪酸和血液乳酸水平均有轻度升高，且升高程度相同。两组患者手术期间血糖均显著升高，且腹部手术组升高幅度在统计学上高于非腹部手术组。研究结果表明，当患者处于饥饿状态且手术期间未接受任何葡萄糖时，在长达3小时的手术干预期间，非腹部手术组和腹部手术组之间的脂肪代谢没有差异。
