Increasing glucose intake during total parenteral nutrition increases norepinephrine excretion in trauma and sepsis.
Increasing glucose intake during total parenteral nutrition increases norepinephrine excretion in trauma and sepsis.
复制标题
全肠外营养期间增加葡萄糖摄入量会增加创伤和败血症时去甲肾上腺素的排泄。
DOI：
10.1111/j.1475-097x.1981.tb00919.x
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发表时间：
1981
期刊：
影响因子：
--
通讯作者：
Kinney,JM
中科院分区：
文献类型：
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作者：
Nordenström,J;Jeevanandam,M;Elwyn,DH;Carpentier,YA;Askanazi,J;Robin,A;Kinney,JM
对15名创伤或感染患者给予全肠外营养（TPN），所有非蛋白质热量均为静脉葡萄糖（葡萄糖系统）或50%葡萄糖+ 50%静脉脂肪（脂质系统）。TPN给药前，非结合去甲肾上腺素的平均尿排泄量为2-37 ± 0-52（SEM）μg/kg/天，显著高于正常受试者（0-62 ± 0-04 μg/kg/天;n= 56）。TPN+葡萄糖系统4-6天后，去甲肾上腺素排泄量由1-95 ± 0-47 μg/kg/d增至6-77 ± 0-95 μg/kg/d（P< 0.01）。当给予含脂质系统的TPN时，增加（从3.05 ± 0.89 μg/kg/天至4.26 ± 0.70 μg/kg/天）无统计学显著性。葡萄糖系统的静息能量消耗适度增加，而脂质系统则没有。TPN期间高葡萄糖负荷的给药，除了提供营养支持外，还可能产生代谢应激，表现为代谢率增加和儿茶酚胺排泄增加。当静脉内脂肪乳剂取代大部分葡萄糖热量时，这些代谢变化会减少。
Total Parenteral Nutrition (TPN) was given to 15 traumatized or infected patients with all of the non‐protein calories, either as intravenous glucose (Glucose System), or as 50% glucose + 50% intravenous fat (Lipid System). Before the administration of TPN, mean urinary excretion of unconjugated norepinephrine was 2–37 ± 0–52 (SEM) μg/kg/day, which is significantly higher than for normal subjects (0–62 ± 0–04 μg/kg/day;n= 56). TPN with the Glucose System for 4–6 days significantly increased the norepinephrine excretion from 1–95 ± 0–47 to 6–77 ± 0–95 μg/kg/day (P< 0.01). When TPN with the Lipid System was given the increase (from 3.05 ± 0.89 to 4.26 ± 0.70 μg/kg/day) was not statistically significant. A modest increase in resting energy expenditure was seen with the Glucose System but not with the Lipid System.The administration of high glucose loads during TPN, in addition to providing nutritional support, may exert a metabolic stress as reflected by increased metabolic rate and increased catecholamine excretion. These metabolic changes are reduced when intravenous fat emulsions are substituted for a major part of glucose calories.