摘要目的 探讨术中静脉输注氨基酸对犬糖代谢的影响.方法 健康成年杂种犬36只,雌雄不拘,体重12～16 kg,全麻下行小肠部分切除术,随机分为4组(n=9):对照组(C组)静脉输注0.9%生理盐水,A1组、A2组和A3组分别于切皮前即刻至术毕静脉输注2.85%、5.70%、11.4%18-氨基酸溶液12 ml·kg-1·h-1.于麻醉前、麻醉诱导后15 min、手术15 min、30 min、1 h、关腹即刻、术后1、2、4、8、24 h时分别抽右股静脉血3 ml,测定血糖、乳酸、胰岛素和胰高血糖素浓度;于麻醉诱导后15 min、关腹即刻、术后24 h时行左后下肢外侧近端肌肉活检,测定肌糖原含量;于关腹即刻、术后24 h时行肝活检,测定肝糖原含量,采用Homa指数估计胰岛素抵抗程度.结果 与麻醉前比较,各组麻醉诱导后15 min至术后24 h时血糖升高,C组术后1 h至24 h时血胰岛素浓度升高,A1组、A2组和A3组手术15 min至术后24 h时血胰岛素浓度升高(P<0.05);与C组比较,A3组麻醉诱导后15 min至术后24 h时血糖升高,A1组关腹即刻、A2组手术15 min及关腹即刻、A3组手术15 min至术后4 h时血胰岛素浓度升高,A2组关腹即刻、A3组手术15 min至术后2 h时Homa指数升高(P<0.05).各组血乳酸浓度及胰高血糖素浓度比较差异无统计学意义(P0.05);组间比较肝糖原、肌糖原含量差异无统计学意义(P0.05).结论 术中静脉输注氨基酸可升高犬血胰岛素浓度,但不抑制糖原分解;低、中剂量氨基酸对血糖无明显影响,术中静脉输注高剂量氨基酸后胰岛素抵抗程度加重,血糖升高.

abstractsObjective To investigate the effect of intraoperative amino acid infusion on perioperative glucose metabolism. Methods Thirty-six adult mongrel dogs of both sexes weighing 12-16 kg undergoing partially small intestine resection under general anesthesia were randomly allocated to one of 4 groups (n=9 each): Ⅰ control group received normal saline (C);Ⅱ,Ⅲ,Ⅳ amino acid group (A1, A2, A3) received iv infusion of 2.85%, 5.70% and 11.4% 18-amino acid respectively at 12 ml·kg-1·h-1 during operation starting from skin incision until the end of operation. The animals were premedicated with ketamine and diazepam. Anesthesia was induced with propofol 5-10 mg/kg, fentanyl 2 μg/kg and vecuronium 0.2 mg/kg and maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and vecuronium. The animals were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. ECG, MAP, HR, PET CO2 and esophageal T0 were continuously monitored. Venous blood samples were collected before anesthesia (T1), 15 min after induction of anesthesia (T2), 15, 30 min and 1 h after skin incision (T3-5), when abdomen was closed (T6) and 1,2,4,8 and 24 h after operation (T7-11) for determination of plasma glucose, lactate, insulin and glucagon. Liver biopsy was performed at T6-11 and muscle biopsy at T2,6,11 for measurement of hepatic and muscle glucagon. Homa index was used to estimate the degree of insulin resistance. Results The plasma glucose and insulin concentrations were significantly increased at T3-11 as compared with the baseline at T1 in all 4 groups (P<0.05). The plasma insulin concentrations were significantly higher in group A1 (at T6), group A2 (at T3,6) and group A3 (at T3-11) than in group C (P<0.05). Homa index was significantly higher in group A3(at T3-8) than in group C. Conclusion Intraoperative amino acid infusion increases plasma insulin concentration but does not prevent glycogenolysis especially high dose amino acid infusion.