[Metabolic intensive care based on the hepatic mitochondrial redox in hepatectomy]

Intraoperative stress (ISS) in hepatectomy was quantified by the serial measurement of blood ketone body ratio (KBR) during operation. ISS was closely related with the decrease in the postoperative KBR and an enhanced postoperative catabolism. Postoperative urinary 3-methylhistidine level was positively and serum retinol binding protein level was negatively correlated with ISS. Intraoperative stress was closely linked with the postoperative metabolic abnormalities. A key stone in the postoperative management in hepatectomy is to elevate KBR. Utilization of energy substrate in the remnant liver is determined by the KBR level. When the KBR is maintained at higher than 0.7, glucose is predominantly utilized, while free fatty acids utilization increases according to the decrease in the KBR. KBR can be an index in the nutritional support after hepatectomy.