Selldén E, Lindahl S G
Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
Anesth Analg. 1998 Sep;87(3):641-6. doi: 10.1097/00000539-199809000-00029.
Amino acid infusions during general anesthesia induce thermogenesis and prevent postoperative hypothermia. The effects of increased heat production during anesthesia on postoperative nitrogen balance have not been examined. Therefore, we studied the effect of perioperative amino acid infusions on postoperative nitrogen excretion in 24 patients scheduled for hysterectomy. Seven volunteers not subjected to anesthesia or surgery were used as awake controls. During isoflurane anesthesia, 8 patients received acetated Ringer's solution, and 16 patients received an IV amino acid mixture, 240 kJ/h, before and during anesthesia. Rectal temperature and energy expenditure were measured. The urinary nitrogen content was calculated from urea, creatinine, and urate the day before surgery and for 4 days postoperatively. Diets were recorded. In anesthetized control patients, postoperative nitrogen excretion was less than preoperative levels. Those patients also experienced the largest decrease in core body temperature during anesthesia (1.7+/-0.1 degrees C). All had postoperative shivering. In the amino acid-treated patients, the temperature decrease during anesthesia was less pronounced (1.0+/-0.1 degrees C; P < 0.001) and postoperative shivering disappeared. In addition, the nitrogen excretion was unchanged postoperatively, perhaps indicating an increase in protein turnover known to generate heat. In conclusion, the increase in heat production induced by amino acids reduced hypothermia, abolished shivering, and attenuated/normalized the postoperative nitrogen saving that occurred in patients who did not receive amino acids.
We compared nitrogen excretion before and after surgery in patients who received a saline or amino acid infusion during isoflurane anesthesia. The increase in heat production induced by amino acids reduced hypothermia, abolished shivering, and attenuated/normalized the postoperative nitrogen saving that occurred in patients who did not receive amino acids.
全身麻醉期间输注氨基酸可诱导产热并预防术后体温过低。麻醉期间产热增加对术后氮平衡的影响尚未得到研究。因此，我们研究了围手术期输注氨基酸对24例计划行子宫切除术患者术后氮排泄的影响。7名未接受麻醉或手术的志愿者作为清醒对照。在异氟烷麻醉期间，8例患者输注醋酸林格液，16例患者在麻醉前及麻醉期间输注静脉用氨基酸混合物，240 kJ/h。测量直肠温度和能量消耗。术前1天及术后4天根据尿素、肌酐和尿酸计算尿氮含量。记录饮食情况。在麻醉的对照患者中，术后氮排泄低于术前水平。这些患者在麻醉期间核心体温下降幅度也最大（1.7±0.1℃）。所有患者术后均出现寒战。在接受氨基酸治疗的患者中，麻醉期间体温下降不明显（1.0±0.1℃；P<0.001），术后寒战消失。此外，术后氮排泄未发生变化，这可能表明已知可产热的蛋白质周转率增加。总之，氨基酸诱导的产热增加减少了体温过低，消除了寒战，并减弱/使未接受氨基酸治疗患者出现的术后氮节省恢复正常。
我们比较了在异氟烷麻醉期间接受盐水或氨基酸输注的患者手术前后的氮排泄情况。氨基酸诱导的产热增加减少了体温过低，消除了寒战，并减弱/使未接受氨基酸治疗患者出现的术后氮节省恢复正常。
