The Effect of Intravenous Nutrition in Patients Undergoing Abdominal Surgery
THE PROTEIN SPARING EFFECT OF PERIOPERATIVE NUTRITION: How Important is the Patient's Catabolic State Before Surgery and do we Need Glucose?
Loss of muscle protein and mass are the main causes of fatigue after bowel surgery which may result in a longer hospital stay and a higher rate of complications. This problem is especially important for patients after surgery for bowel cancer because cancer itself causes a waste of muscle protein. Anesthesiologists can decrease these negative effects of surgery by choosing the type of pain treatment (analgesia) and by giving nutrition (sugar and protein). Our group recently observed that optimal pain relief with epidural catheters (these are placed in the so called epidural space, which lies between the spine and the skin of the back) in combination with a low calorie protein diet intravenously (through the vein) maintains the body's protein stores after bowel surgery.
The goal of our new research program is to find out whether this protein saving effect depends on how protein depleted the patient is before surgery. In other words we would like to answer the question: do cancer patients who show protein wasting before the operation benefit more from feeding than patients who show no signs of protein wasting? A second goal of this program is to find out if we need to use sugar as part of the diet or whether the infusion of protein alone is sufficient. Just giving protein would make feeding not only easier but also would avoid the increase in the patient's own blood sugar during and after the operation, which typically occurs when sugar is given intravenously during that period.
調査の概要
詳細な説明
- Goals The overall goal of perioperative nutrition support is to abolish protein wasting and to promote anabolic processes by directing amino acids into protein synthesis rather than oxidation. Protein repletion and enhancement of anabolism appear to be particularly important in cancer patients who enter major abdominal surgery in a catabolic state.
Objectives The objectives of this research program are
- to examine whether the anabolic effects of hypocaloric nutrition depend on the degree of catabolism before the operation and thus identify patients who benefit the most from perioperative nutrition support (study I)
- to investigate whether excluding glucose from hypocaloric nutrition, i.e. infusing an isonitrogenous amount of amino acids without glucose avoids hyperglycemia and, thus, accentuates the patient's anabolic response to feeding (study II).
In order to confirm the validity of our assumptions we will perform two consecutive studies in two distinct patient populations. For the assessment of the patients' catabolic state and obtaining insight into the biochemical mechanisms, whereby the effects of nutrition are mediated, stable isotope tracer kinetics will be applied. Using primed continuous infusions of L-[1-13C]leucine and [6,6-2H2]glucose we will quantitate the whole body dynamics of protein and glucose metabolism, i.e. protein breakdown, amino acid oxidation, protein synthesis, glucose production and glucose uptake before and after surgery. A positive protein balance (difference between protein synthesis and protein breakdown) will be used as an indicator of anabolism. Anabolic processes at the organ level (liver, muscle), i.e. fractional synthesis rates of the acute phase proteins albumin and fibrinogen and muscle protein synthesis will be determined using L-[2H5]phenylalanine infusions. Skeletal muscle protein catabolism will be characterized by measuring the mRNA expression of ubiquitin and two of its key ligases in muscle (MAFbx/atrogen-1 and MuRF-1).
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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-
Quebec
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Montreal、Quebec、カナダ、H3A 1A1
- Royal Victoria Hospital, McGill University Health Centre
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- American Society of Anesthesiologists <3
- colorectal surgery for non-metastatic colorectal carcinoma including right and left hemicolectomy, transverse, subtotal and total colectomy, sigmoid resection
- ability to give informed consent
Exclusion Criteria:
- signs of severe malnutrition or obesity: body mass index <18 or >25 >10% involuntary body weight loss over the preceding 6 months serum albumin <21 g/L
- significant cardiorespiratory, hepatic, renal and neurological disease
- ingestion of drugs known to affect protein, glucose and lipid metabolism (for example steroids)
- musculoskeletal or neuromuscular disease
- severe anemia (hemoglobin <10 g/dL)
- pregnancy
- history of severe sciatica or back surgery or other conditions which
- contraindicate the use of epidural catheters
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：処理
- 割り当て：非ランダム化
- 介入モデル：並列代入
- マスキング：独身
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的：Glucose and amino acids
Perioperative nutrition with glucose and amino acids
|
ブドウ糖およびアミノ酸の静脈内投与は、手術の 20 時間前から開始し、手術後 2 日目まで行います。
各患者の測定された安静時エネルギー消費の 50% がグルコース、20% がアミノ酸です。
|
|
アクティブコンパレータ：Amino acids only
Perioperative nutrition with amino acids only
|
Amino acids intravenously starting 20 hours before the operation until the second postoperative day.
Amino acids providing 20% of each patient's measured resting energy expenditure.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
時間枠 |
|---|---|
|
タンパク質バランス
時間枠：手術の二日後
|
手術の二日後
|
二次結果の測定
結果測定 |
時間枠 |
|---|---|
|
albumin synthesis
時間枠：two days after surgery
|
two days after surgery
|
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fibrinogen synthesis
時間枠：two days after surgery
|
two days after surgery
|
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total plasma protein synthesis
時間枠：two days after surgery
|
two days after surgery
|
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mRNA expression of ubiquitin
時間枠：two days after surgery
|
two days after surgery
|
協力者と研究者
捜査官
- 主任研究者：Thomas Schricker, MD PhD、Department of Anaesthesia, McGill University Health Centre
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- CIHR-2011
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