临床营养中糖溶液的最新进展
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中国临床营养杂志000136Recent advances of carbohydrates solution in clinical nutrition
Harumasa Ohyanagi ,MD ,Ph. D
(Professor and Chairman Department of Surgery Ⅱ Kinki University, School of Medicine, Osaka-Sayama, Osaka, Japan)
Glucose is the most frequently chosen energy source during intravenous nutrtion. Despite having the most physiological properties, glucose has been recognized as having some metabolic disadvantages in stressed patients, such as those in apostoperative state, with sepsis, or with burns.
, http://www.100md.com
In an attempt to improve patient care and to alleviate adverse metabolic effects, our study was undertaken to investigate carbohydrate sources in parenreral nutrition experimentally and clinically in the context of their metabolism.
Tracer studies in rats using 14C-labeled carbohydrates confirmed that glucose is the most rapidly converted into CO2 in all conditions, including diabetes mellitus.
Isocaloric carbohydrates solutions combined glucoso, fructose and xylitol in varying ratios were administered into rabbits or rats under depressed glucose metabolism such as surgical stress, diabetes meUitus, or sepsis. The serum glucose level of early postoperative rabbits was significantly lower in the groups with relatively smaller glucose concentrations because of the increase in relative fructose and xylitol intake.
, http://www.100md.com
Urinary excretion of glucose and total suger was significantly reduced in the glucose, fructose xylitol (GFX)-8: 4: 2 group. However, the GFX-8: 4: 2 group maintained better nitrogen balance than other groups.
The cumulative curves of expired 14CO2 after injection of radioactive glucose with GFX solutions showed that GFX-8: 4: 2 enhanced glucose utilization in the early postoperative period.
Tracer studies with 15N-glycin in rats showed that carbohydrate mixture of GFX-8: 4: 2 increased the protein synthesis in the liver just after operative stress more remarkably than glue0se alone.
, http://www.100md.com
There results confirmed that GFX-8: 4: 2 gave the best metabolic advatage for the following reasons: 1) the administered glucose concentration was relatively lower becauseof the increased fructose and xylitol contents and yielded a lower serum glucose level, 2)the significantly lower level of serum glucose reduced the burden for the pancreas to secrete inaulin, and 3) administered fructose and xylitol enhanced glucose utilization and further metabolism, including protein synthesis.
, 百拇医药
Clinically available GFX solutions are prepared in two types: one for total parenteral nutrition (TPN) (23w/v% as total carbohydrates for initial use and 29w/v% for maintenance) and one for peripheral or hypoeadonic parenteral nutrition (PPN) ( 10.5 % of total carbohydrates).
Serum glucose levels on the third and fifth postperative days tended to be lower in the GFX-TPN group. Plasma insulin levels showed a similar trend.
On the basis of the results of blood glucose control and urinary carbohydrate excretion in TPN and PPN of patients care this mixture of three carbohydrates have also been proven efficacious in blood glucose control, particularly during the early postoperative period.
, 百拇医药
葡萄糖是肠外营养时最常选用的能量来源。虽然葡萄糖供能最符合生理情况，但在应激病人，如术后、严重感染及烧伤病人，葡萄糖对机体代谢有不利影响。
为了改善治疗效果和减轻碳水化合物在代谢方面的不利影响，我们在动物和临床研究中观察了碳水化合物在代谢中的作用。利用14C标记的碳水化合物在大鼠中进行的示踪实验表明，在包括糖尿病的所有状态下，葡萄糖是最快转化为CO2的碳水化合物。给予应激状态(手术、糖尿病、严重感染)的兔和大鼠等热卡的碳水化合物溶液，这些溶液由葡萄糖、果糖和木糖醇以不同比例混合而成。在葡萄糖浓度低的一组，术后早期血清葡萄糖水平也低。在葡萄糖、果糖和木糖醇以8：4：2比例供给的一组，尿中葡萄糖和总糖的排出明显减少，而且这组的氮平衡较其它比例组为好。
利用14C标记的葡萄糖进行的同位素示踪实验结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给在术后早期可增加葡萄糖的利用。利用15N标记的甘氨酸进行的同位素示踪实验结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给比单独使用葡萄糖明显增加术后肝脏的蛋白质合成。
, 百拇医药
研究结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给有最好的代谢效应。这是因为：①输入液的葡萄糖浓度较低，血清葡萄糖水平也低；②较低的血清葡萄糖水平减轻了胰腺分泌胰岛素的负担；③果糖和木糖醇增加了葡萄糖的利用和蛋白质合成。
临床使用的葡萄糖、果糖和木糖醇的混合液有两种：一种是为全肠外营养使用的(初期使用总糖含量为23w/v%、以后使用29w/v%)，一种是为经周围静脉或低热卡肠外营养使用的(总糖含量为10.5w/v%)。
给予葡萄糖、果糖和木糖醇混合液的肠外营养组，在术后第3、5天显示血清葡萄糖水平有下降趋势，血浆胰岛素水平也有类似的变化。在肠外营养中使用这三种碳水化合物的混合液，可有效地控制血糖水平，尤其在术后早期。, http://www.100md.com
单位：
关键词：
中国临床营养杂志000136Recent advances of carbohydrates solution in clinical nutrition
Harumasa Ohyanagi ,MD ,Ph. D
(Professor and Chairman Department of Surgery Ⅱ Kinki University, School of Medicine, Osaka-Sayama, Osaka, Japan)
Glucose is the most frequently chosen energy source during intravenous nutrtion. Despite having the most physiological properties, glucose has been recognized as having some metabolic disadvantages in stressed patients, such as those in apostoperative state, with sepsis, or with burns.
, http://www.100md.com
In an attempt to improve patient care and to alleviate adverse metabolic effects, our study was undertaken to investigate carbohydrate sources in parenreral nutrition experimentally and clinically in the context of their metabolism.
Tracer studies in rats using 14C-labeled carbohydrates confirmed that glucose is the most rapidly converted into CO2 in all conditions, including diabetes mellitus.
Isocaloric carbohydrates solutions combined glucoso, fructose and xylitol in varying ratios were administered into rabbits or rats under depressed glucose metabolism such as surgical stress, diabetes meUitus, or sepsis. The serum glucose level of early postoperative rabbits was significantly lower in the groups with relatively smaller glucose concentrations because of the increase in relative fructose and xylitol intake.
, http://www.100md.com
Urinary excretion of glucose and total suger was significantly reduced in the glucose, fructose xylitol (GFX)-8: 4: 2 group. However, the GFX-8: 4: 2 group maintained better nitrogen balance than other groups.
The cumulative curves of expired 14CO2 after injection of radioactive glucose with GFX solutions showed that GFX-8: 4: 2 enhanced glucose utilization in the early postoperative period.
Tracer studies with 15N-glycin in rats showed that carbohydrate mixture of GFX-8: 4: 2 increased the protein synthesis in the liver just after operative stress more remarkably than glue0se alone.
, http://www.100md.com
There results confirmed that GFX-8: 4: 2 gave the best metabolic advatage for the following reasons: 1) the administered glucose concentration was relatively lower becauseof the increased fructose and xylitol contents and yielded a lower serum glucose level, 2)the significantly lower level of serum glucose reduced the burden for the pancreas to secrete inaulin, and 3) administered fructose and xylitol enhanced glucose utilization and further metabolism, including protein synthesis.
, 百拇医药
Clinically available GFX solutions are prepared in two types: one for total parenteral nutrition (TPN) (23w/v% as total carbohydrates for initial use and 29w/v% for maintenance) and one for peripheral or hypoeadonic parenteral nutrition (PPN) ( 10.5 % of total carbohydrates).
Serum glucose levels on the third and fifth postperative days tended to be lower in the GFX-TPN group. Plasma insulin levels showed a similar trend.
On the basis of the results of blood glucose control and urinary carbohydrate excretion in TPN and PPN of patients care this mixture of three carbohydrates have also been proven efficacious in blood glucose control, particularly during the early postoperative period.
, 百拇医药
葡萄糖是肠外营养时最常选用的能量来源。虽然葡萄糖供能最符合生理情况，但在应激病人，如术后、严重感染及烧伤病人，葡萄糖对机体代谢有不利影响。
为了改善治疗效果和减轻碳水化合物在代谢方面的不利影响，我们在动物和临床研究中观察了碳水化合物在代谢中的作用。利用14C标记的碳水化合物在大鼠中进行的示踪实验表明，在包括糖尿病的所有状态下，葡萄糖是最快转化为CO2的碳水化合物。给予应激状态(手术、糖尿病、严重感染)的兔和大鼠等热卡的碳水化合物溶液，这些溶液由葡萄糖、果糖和木糖醇以不同比例混合而成。在葡萄糖浓度低的一组，术后早期血清葡萄糖水平也低。在葡萄糖、果糖和木糖醇以8：4：2比例供给的一组，尿中葡萄糖和总糖的排出明显减少，而且这组的氮平衡较其它比例组为好。
利用14C标记的葡萄糖进行的同位素示踪实验结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给在术后早期可增加葡萄糖的利用。利用15N标记的甘氨酸进行的同位素示踪实验结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给比单独使用葡萄糖明显增加术后肝脏的蛋白质合成。
, 百拇医药
研究结果表明，葡萄糖、果糖和木糖醇以8：4：2比例供给有最好的代谢效应。这是因为：①输入液的葡萄糖浓度较低，血清葡萄糖水平也低；②较低的血清葡萄糖水平减轻了胰腺分泌胰岛素的负担；③果糖和木糖醇增加了葡萄糖的利用和蛋白质合成。
临床使用的葡萄糖、果糖和木糖醇的混合液有两种：一种是为全肠外营养使用的(初期使用总糖含量为23w/v%、以后使用29w/v%)，一种是为经周围静脉或低热卡肠外营养使用的(总糖含量为10.5w/v%)。
给予葡萄糖、果糖和木糖醇混合液的肠外营养组，在术后第3、5天显示血清葡萄糖水平有下降趋势，血浆胰岛素水平也有类似的变化。在肠外营养中使用这三种碳水化合物的混合液，可有效地控制血糖水平，尤其在术后早期。, http://www.100md.com