果糖对肝硬化脾切除术患者肝脏能量代谢的影响

Effects of fructose on energy metabolism of. liver in patients with liver cirrhosis undergoing elective splenectomy

目的 探讨果糖对肝硬化脾切除术患者肝脏能量代谢的影响。方法择期全麻下行脾切除术的肝硬化门脉高压症患者30例，ASAⅡ或Ⅲ级，随机分为2组（n=15），对照组静脉输注复方电解质注射液、新鲜冰冻血浆200—300ml及冷沉淀6～8U，控制输液速度12～14ml·kg^-1·h^-1；果糖组静脉输注5％果糖5ml·kg^-1·h^-1、复方电解质注射液、新鲜冰冻血浆200～300ml及冷沉淀6～8u。控制两组输液总量一致。于术前、切皮后1h及术后1h分别抽取中心静脉血4ml，测定微量血糖（MBG）及血清胰岛素（Ins）浓度，计算胰岛素敏感性指数[ISI=-In（Ins×MBG）]；同时抽取桡动脉血4ml行血气分析，测定乙酰乙酸（AcAc）及β-羟丁酸（β—OHB）浓度，计算动脉血酮体比值（AKBR=AcAc／β-OHB）。测定术前、术后1d及3d时肝、肾功能指标。结果与术前相比，果糖组术后1h时AKBR明显升高，对照组术后3d时血清谷丙转氨酶、谷草转氨酶浓度明显升高（P〈0．05）。与对照组比较，果糖组术后1h时AKBR明显升高，术后3d时血清谷丙转氨酶、谷草转氨酶浓度明显降低（P〈0．05）。两组ISI和肾功能各项指标比较差异无统计学意义（P〉0．05）。结论肝硬化脾切除术患者术中静脉输注果糖（5ml·kg^-1·h^-1）可改善肝脏线粒体功能，恢复肝脏正常能量代谢。

Objective To investigate the effects of fructose on energy metabolism of liver in patients with liver cirrhosis undergoing elective splenectomy. Methods Thirty ASA Ⅱ or Ⅲ patients with liver cirrhosis and portal hypertension aged 21-58 yr weighing 45-70 kg undergoing elective splenectomy were randomly divided into 2 groups （n = 15 each） ： control group （C） received iv infusion of plasmalyte A and blood products during operation and fructose group（F） received iv infusion of fructose at 5 ml·kg^-1·h^-1 besides plasmalyte A and blood products. The patients were premedieated with im phenobarbital 0, 1 g and atropine 0.5 mg. Anesthesia was induced with midazolam 0.05 mg/kg, fentanyl 4μg/kg, propofol 1,0-1.5 mg/kg and atracurium 0,6 mg/kg and maintained with 1.0 MAC isoflurane. The patients were mechanically ventilated after tracheal intubation, Blood samples were taken from internal jugular vein and radial artery at the same time before operation （T0 , baseline）, at 1 h after skin incision （T1 ） and 1 h after operation. Venous blood samples were taken for determination of blood glucose concentration and serum insulin level. Insulin sensitivity index （ISI） was calculated, Arterial blood samples were obtained for blood gas analysis and determination of blood concentration of acetoacetic acid （AcAc） and β-hydroxybutyric acid （β-OHB）. Arterial ketone body ratio （AKBR） was calculated. Hepatic and renal functions were performed before operation and at 3 days after operation. Results AKBR was significantly higher after operation in group F than in group C. The degree of elevation of serum glutamic-oxaloacetic transaminase （GOT） and glutamic-pyruvic transaminase （GPT） after operation was significantly smaller in group F than in group C. There was no significant difference in ISI between the two groups. Conclusion Intravenous fructose infusion at 5ml·kg^-1·h^-1 during operation may improve liver mitochondrial function and speed recovery of norulal encrgy production in patients with liver cirrhosis undergoing elective splenectomy.