Evaluation of a carbohydrate-free diet for patients with severe head injury
Evaluation of a carbohydrate-free diet for patients with severe head injury
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DOI：
10.1089/neu.1996.13.473
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发表时间：
1996-08-01
影响因子：
4.2
通讯作者：
Grossman, RG
中科院分区：
文献类型：
--
作者：
Ritter, AM;Robertson, CS;Grossman, RG
高血糖可由常规饮食引起或加重，可使严重颅脑损伤后的神经系统预后恶化，特别是继发性缺血性损伤发生时。本研究的目的是评估一种实验性饮食，旨在替代全身热量和蛋白质需求而不产生高血糖。在实验室的初步研究中，采用5种实验饲料建立大脑中动脉暂时性闭塞模型。比较了不同日粮对空腹动物和对照组动物血液生化和梗死体积的影响。饲喂实验饲料的动物缺血前血糖浓度明显低于对照组，血酮体浓度明显高于对照组，梗死体积明显小于对照组。从实验室研究中选择一种饮食，然后在临床研究中作为随机、开放标签试验进行评估。选取20例重度颅脑损伤患者，在损伤后的前2周随机饲喂实验饲粮EN-9305和对照饲粮Osmolyte HN。在开始指定饮食的第1天，两个治疗组的血糖浓度相似，平均为6.33 +/- 0.21 μ mol/mL （114 +/- 4 mg/dL）。随着饲粮输注速率增加至终速，对照组血糖浓度在第7天达到峰值8.37 +/- 0.94 mu mol/mL （151 +/- 17 mg/dL）。在实验饮食组中，随着饮食的推进，血糖浓度与禁食水平保持不变。饲喂试验饲粮的患者血乳酸浓度较低，血酮体浓度较高。实验饮食组尿氮平衡较好，但内脏蛋白节约指标，包括血清白蛋白、血浆视黄醇结合蛋白和总淋巴细胞计数，在两个治疗组之间无显著差异。脑无氧代谢指标，包括脑脊液乳酸浓度和脑乳酸生成，在两个治疗组间无显著差异。这些研究表明，像EN-9305这样的无碳水化合物饮食可能对严重头部损伤患者有好处，因为它可以替代全身热量和蛋白质需求，而不会产生高血糖。
Hyperglycemia, which may be caused or exacerbated by conventional diets, may worsen the neurological outcome from severe head injury, especially if secondary ischemic insults occur. The purpose of this study was to evaluate an experimental diet intended to replace systemic caloric and protein requirements without producing hyperglycemia. In initial studies in the laboratory, 5 experimental diets were employed in a middle cerebral artery temporary occlusion model. The effects of the diets on blood biochemistry and on infarction volume were compared in fasted animals and in animals fed a control diet. Animals fed the experimental diets had a significantly lower preischemia blood glucose concentration, a higher blood concentration of ketone bodies, and a smaller infarct volume than the animals fed a control diet. One diet chosen from the laboratory study was then evaluated in a clinical study as a randomized, open-label trial. Twenty severely head-injured patients were randomly assigned to be fed the experimental diet, EN-9305, or the control diet, Osmolyte HN, for the first 2 weeks after injury. Both treatment groups had similar blood glucose concentrations, averaging 6.33 +/- 0.21 mu mol/mL (114 +/- 4 mg/dL), on day 1 prior to starting the assigned diet. Blood glucose concentration increased in the control diet group to a peak of 8.37 +/- 0.94 mu mol/mL (151 +/- 17 mg/dL) on day 7 as the infusion rate of the diet was increased to the final rate. In the experimental diet group, the blood glucose concentration remained unchanged from fasting levels as the diet was advanced. Blood lactate concentration was lower, and blood ketone body concentrations were higher in the patients fed the experimental diet. Urinary nitrogen balance was better in the experimental diet group, but measures of visceral protein sparing, including serum albumin, plasma retinol binding protein, and total lymphocyte count, were not significantly different in the 2 treatment groups. Measures of cerebral anaerobic metabolism, including CSF lactate concentration and cerebral lactate production, were not significantly different in the 2 treatment groups. These studies suggest that a carbohydrate-free diet such as EN-9305 might have advantages for patients with severe head injury by replacing systemic caloric and protein requirements without producing hyperglycemia.