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[Parenteral feeding following heart surgery operations]
Infusionstherapie Und Klinische Ernahrung
|December 1, 1984
Summary
Hypocaloric parenteral nutrition improved nitrogen balance in post-cardiac surgery patients. However, it did not enhance visceral serum protein levels, despite increased insulin secretion.
Area of Science:
- Cardiology
- Metabolic Medicine
- Surgical Nutrition
Background:
- Post-aorto-coronary bypass surgery patients often require nutritional support.
- Optimizing parenteral nutrition (PN) is crucial for recovery and metabolic balance.
- Understanding the impact of different carbohydrate formulations in PN is essential.
Purpose of the Study:
- To evaluate the effects of three hypocaloric PN regimens with varying carbohydrate compositions on metabolic changes in patients after aorto-coronary bypass surgery.
- To compare these PN regimens against a control group receiving a lower dextrose dose.
- To assess impacts on carbohydrate and protein metabolism, including blood glucose, insulin levels, nitrogen balance, and visceral protein concentrations.
Main Methods:
- Prospective-randomized study involving 40 patients post-aorto-coronary bypass.
- Four groups received different hypocaloric PN formulations (75g amino acids daily) with varying carbohydrate types and amounts (dextrose, or dextrose/fructose/xylitol mix).
- A control group received 75g dextrose/day. Fluid volume was limited to 1500 ml/day. Metabolic parameters were monitored.
Main Results:
- All PN groups showed significantly increased postoperative serum insulin levels (4-5 fold) without requiring exogenous insulin, maintaining blood glucose between 7-10 mmol/l.
- Serum potassium levels remained normal with 80-100 mmol/day supply.
- Cumulative nitrogen balance improved by 48-58% in PN groups compared to controls, despite low calorie/nitrogen ratios (40:1 or 66:1).
- No significant improvements were observed in visceral serum protein concentrations (transferrin, prealbumin, retinol-binding protein, cholinesterases).
Conclusions:
- Hypocaloric parenteral nutrition, even with varying carbohydrate mixtures, effectively improves nitrogen balance in patients post-cardiac surgery.
- While PN can manage blood glucose and insulin response, it does not appear to significantly boost visceral protein synthesis in the short term.
- Further research is needed to optimize PN strategies for improving visceral protein markers in surgical patients.