低热卡肠外营养对术后病人代谢反应的影响

目的等氮量不同热卡的肠外营养支持，对手术创伤病人代谢反应的影响。方法53例胃癌根治术病人，随机分为标准热卡组27例，低热卡组26例，术后1～7天进行等氮量不同热卡的肠外营养支持。监测术前3天，术后第1、3、7天体温、血糖、血清白蛋白、前白蛋白、24小时尿尿素氮和尿肌酐的排泄量和应激代谢相关激素的变化。结果两组病人术后第1天，体温、血糖、应激代谢相关激素、尿尿素氮和尿肌酐排泄量较术前升高（P＜0．05）。术后第3天，两组体温、血糖、尿尿素氮和尿肌酐排泄量、胰岛素、醛固酮仍高于术前水平（P＜0．05），两组相比低热卡组升高水平较低（P＜0．05）。术后第7天，低热卡组除24小时尿素氮和尿肌酐排泄量仍较术前高（P＜0．05）外，体温、血糖及应激代谢相关激素恢复到术前水平。标准热卡组血糖、尿尿素氮和尿肌酐排泄量、胰岛素和醛固酮水平仍较术前升高（P＜0．05），与低热卡组相比差异有显著性（P＜0．05）。两组病例血浆白蛋白、前白蛋白、胰高血糖素和皮质醇激素变化比较差异无显著性（P＞0.05）。结论对中重度手术创伤病人，提供20Kcal·kg-1·d-1左右的非蛋白热卡，更符合其代谢特点，有利于创伤应激反应的恢复。

Effect of TPN with hypocaloric regimens on metabolic responses of postoperative surgical patients

Objective To study the effects of different caloric and isonitrogenous peranteral nutritional support on metabolic response of postoperative surgical patients. Methods 53 patients under went radical operation for carcinoma of stomach were randomized into standard caloric groups (n = 27) and hypocaloric groups (n = 26), they received isonitrogenous and different caloric parenteral nutritional support from postoperative day 1 to day 7. The body temperature (BT), serum glucose,albumin, prealburmin, catabolic hormone (insulin, glucagon, cortisol and aldosterone), urea excrtory quantity of urea nitrogen (UUN) and urea creatinine (UCr) were examined 3 days before operation and the 1,3, 7 day after operation. Results In the first postoperative day, the BT, blood glucose, catabolic hormone, excretory excretory quantity of UUN and UCr increased in all the cases. On the 3r postoperative day, BT, blood glucose, insulin, aldosterone, excretory quantity of UUN and UCr also rised (P< 0.05) against preoperation in hypocaloric groups, but significantly reduced compared with standard caloric groups. The 7 day after operation, in hypocalcoric groups, the excretory quantity of UUN and UCr also rised, but BT, blood glucose and catabolic hormone returned to normal level. In contrast, blood glucose, the excretory quantity of UUN and UCr, insulin and aldosterone were significantly elevated in standard caloric groups. The changing of serum albumin, prealbumin, glucagon and cortisol level between two groupe did not have statistical difference. Conclusions In postoperative patients, cataboic hormone increased, the blood glucose disposal decreased and endogenous glucose production increased as a result of the elevation of blood glucose level, the protein catabolism, urea excretory quantity of urea nitrogen and urea creatinine also increased. Hypocaloric parenteral nutrition contribute to improve the body temperature,mini the effects on catabolic hormone and carbohydrate metabolism, reduce the excretory quantity of urea excretory quantity of urea nitrogen and urea cratinine. In contrast, standard caloric nutriton, enhanced blood glcose and catabolic hormone level,increased protein catabolism. Therefore, we recommended the hypocaloric parentenal nutrition support for postoperative patients.