| Objective To observe the preoperative effects of intraoperative branched chain amino acid infusion on glycometabolism, lipid metabolism and body temperature.Methods Forty gastrointestinal tumor patients, undergoing gastrointestinal tumor surgery under general anesthesia combined with epidural block, were randomly assigned to receive intraoperative infusion of 3-compound branched chain amino acids(Group 3AA, N=20) at 5.6 ml·kg-1.h-1 or normal saline (Group NS, N=20). Nasopharyngeal temperature, blood glucose, plasma insulin, blood free fatty acid and blood ketone bodies concentrations were measured 30 min before induction(To),10 min after induction(T1),30 min and 2h after skin incision (T2, T3), and 1h after tracheal extubation(T4). SPSS 20.0 was applied to ana-lyze the differences between and within the two groups for baseline information and re-peated measurement during the research (nasopharyngeal temperature, blood glucose, plasma insulin, blood free fatty acid and blood ketone bodies concentrations) and the inten-sity of shivering and pain 1h after tracheal extubation.Results (1) One case was rejected since the surgical method was hepato-hemicolectomy. The gender, age, BMI, surgery duration, fluid infusion, interfering fluid in-fusion, urinary production and bleeding during surgery were not different significantly in the two groups (P>0.05). (2) The intraoperative nasopharyngeal temperature in two groups were significantly lower than basal, while the temperature in 3AA group was significantly higher than that in NS group 1h after extubation (1h after extubation:3AA group 36.39± 0.40℃, NS group 36.05±0.49℃,P<0.05). The incidence of visible muscular activity and intensity of shivering in 3AA group was lower than NS group significantly. (3) Blood glu-cose in both groups increased significantly during and after surgery, but there was no sig-nificant difference between the two groups in general(P>0.05). (4) At the same time point, plasma insulin concentration in 3AA group was significantly higher than NS group during surgery (P<0.05). The plasma insulin concentration increased significantly in 3AA group during the surgery (P<0.05) and fell 1h after extubation. (30min before induction: 4.83±2.40±U/ml in 3AA group,3.34±2.50μU/ml in NS group, P> 0.05; 2h after skin incision:12.72±7.83 μU/ml in 3AA group,2.57±1.62 μU/ml in NS group, P< 0.05;1h after extubation:10.56±5.53 μU/ml in 3AA group,4.03±2.98 μU/ml in NS group, P< 0.05). (5) There was no significant difference in blood ketone bodies between two groups. (6) Plasma free fatty acids concentration decreased significantly during and after surgery in 3 AA group (P< 0.05), while the concentration in NS group fell at the beginning of surgery, hit the bottom 30min after the skin incision and then rise till 1h after extubation. (30min before induction:0.86±0.30 mmol/L in 3AA group,0.96±0.29 mmol/L in NS group, P> 0.05; 1h after skin incision:0.47±0.14 mmol/L in 3AA group,0.59±0.23 mmol/L in NS group, P> 0.05; 2h after skin incision:0.42±0.19 mmol/L in 3AA group,0.74±0.37 mmol/L in NS group, P< 0.05;1h after extubation:0.37±0.19 mmol/L in 3AA group,0.86 ±0.39 mmol/L in NS group, P< 0.05) The difference between two groups was significant (P<0.05).Conclusions Intraoperative branched chain amino acids infusion can inhibit fat mobili-zation, while does not create extra ketone bodies, does not increase the intensity of blood glucose rise during the surgery as well as increases insulin secretion, alleviates the intensity of shivering after surgery, but has no significant effect on intraoperative hypothermia. |
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