消化道肿瘤患者手术前后代谢改变研究  

Metabolic studies in gastrointestinal cancer patients before and after surgery

作　　者：全应军[1] 吴国豪[2] 郑烈伟[2] 吴肇汉[2] 

机构地区：[1]复旦大学附属上海市第五人民医院普外科,上海200240 [2]复旦大学附属中山医院普外科

出　　处：《上海医学》2006年第8期530-533,共4页Shanghai Medical Journal

摘　　要：目的评估消化道肿瘤根治术对机体能量和物质代谢的影响,并评价个体化能量供给对消化道肿瘤手术应激患者能量和物质代谢的影响。方法60例行腹部中、大型手术的消化道肿瘤患者随机均分为营养支持组(术后当天按术前测定的能量消耗量开具营养配方)和普通补液组(术后第1天起每天输注5%或10%葡萄糖100～150 g)。肠道功能恢复后,可经口饮食。采用间接能量代谢测定仪测定氧气消耗量(VO_2)、二氧化碳产生量(VCO_2)、呼吸商(RQ)、静息能量消耗(REE)。测量时间分别为术前和术后第1、3、7天。并计算患者手术前、后底物氧化量、能量代谢平衡、氮平衡,监测患者前白蛋白浓度变化。结果与术前相比,营养支持组术后第1、3天的REE显著增加,术后第3天的增幅显著高于普通补液组(P＜0．05)；术后第7天降至术前水平以下。两组术后RQ均下降,营养支持组术后第3天的降幅显著小于普通补液组(P＜0．05)。营养支持组葡萄糖利用、脂肪动员改变等均较普通补液组缓和。术后第7天,营养支持组的氮平衡和能量平衡均由术前负代谢平衡变为正代谢平衡,与普通补液组的差异有显著性(P＜0．01)。术后第7天营养支持组前白蛋白浓度显著高于普通补液组(P＜0．01)。结论不伴并发症的择期消化道肿瘤手术后REE变化较小,术后不必增加能量供给。根治性肿瘤切除后患者REE值有下降趋势；个体化能量供给可在一定程度上减轻术后机体应激程度,改善能量和氮代谢平衡及患者营养状态。Objective： To assess the impact of surgical stress on energy metabolism, nitrogen balance and substrate utilization in gastrointestinal cancer patients. Addtionally, we evaluate the effect of individualized energy support on this impact. Methods Sixty gastrointestinal cancer patients undergone major abdominal operations were randomly selected and divided into two groups. Control group（n=30）received 100-150 g glucose daily, study group（n = 30） accepted individualized parenteral nutrition support according to preoperative MREE. REE of these patients were consecutively measured preoperatively（POD0）, and on the 1^st （POD1）. 3^rd （POD3） .7^th （PODT） postoperative days using indirect calorimetry. In addition, we measured the energy and nitrogen balance, suhstrate utilization. The concentration of serum prealbumin was also determined. Results Postoperative REE of the study group was higher than preoperative REE on POD1 and POD3（P〈0.05）, also higher than that of the control group on POD3（P〈0.05）. The decreased amplitude of respiratory quotient（RQ） in the study group was found to be lower than that in the control group on POD3（P〈0.05）. After 7 days of nutrition support, most patients of the study group showed improving ability to oxidize glucose, but whole-body fat oxidation decreased significantly with energy and nitrogen balance became slightly positive. The serum prealbumin of the study group was obviously more than that of the control group on PODT（P〈0.01）. Conclusions Energy requirements of patients undergoing major surgical stress are lower than that of generally presumed therefor no need for energy supplement. The radical tumor resection resulted in prompt declining of the energy expenditure indicating for individualized energy support to improve the patients＇ energy and nitrogen balance, substrate utilization and nutritional status.

关 键 词：静息能量消耗 间接测热法 底物利用 手术应激 营养支持 肿瘤 

分 类 号：R735[医药卫生—肿瘤] R654.2[医药卫生—临床医学]