[Study of metabolic dynamics under severe surgical stress--investigation by the method of respiratory gas analysis]

To elucidate quantitative analysis of the hypermetabolic status and classification of energy substrates kinetics, the metabolic dynamics after radical operation for thoracic esophageal cancer was investigated in 10 patients primarily by the method of respiratory gas analysis. 1) REE showed almost 30 kcal/kg/day and no significant change on each postoperative day. Energy intake in addition to surgical stress influenced the metabolic dynamics (specific dynamic action: SDA). So authors originally devised a postoperative metabolic index "PMI" in consideration for the effect of SDA. PMI is defined; PMI = (REE kcal/day-BEE kcal/day)/Energy Intake (non-protein kcal/day). according to PMI, it was clarified that the hypermetabolic status reached a maximum value on the first postoperative day, showed a steep decrease up to the 3rd postoperative day and afterwards slow recovery. PMI revealed a significant correlation (r = 0.792, p < 0.001) with daily urinary epinephrine excretion in the immediate postoperative period (up to the 3rd day). These results suggest PMI might be useful in the quantitative evaluation of the hypermetabolic status under surgical stress. 2) Energy substrates kinetics was clearly classified into six patterns according to three parameters such as energy balance, glucose balance, and predominant fat metabolism (fat oxidation or synthesis).