Contrasting effects of identical nutrients given parenterally or enterally after 70% hepatectomy.

摘要: Based on clinical observations, we hypothesized that prolonged parenteral nutrition (in contrast to enteral nutrition) is detrimental after major hepatic resection. Male Sprague-Dawley rats (300 380 g) anesthetized with intraperitoneal sodium pentobarbital had 70% resection and jugular vein gastrostomy catheterizations using aseptic techniques were divided randomly into three groups: (1) total (TPN) (nutrients via central vein), (2) (TEN) (identical nutrients gastrostomy), (3) standard oral feeding (SOF) (chow water ad libitum). Unused catheters plugged. In the first set of experiments (n = 42), nutrient intake was formulated approximate nutritional normal rats, 216 kcal/kg/d. Infusate 15% glucose, 4.5% amino acids, electrolytes, trace minerals, vitamins, 20% fat emulsion given half-strength day, three-fourths strength second full thereafter. On postoperative day 7, surviving killed. Mortality prior 7 very high (68%) in TPN group low TEN (9%) SOF groups (p < 0.005). Among survivors, serum albumin level lowest 0.002) bilirubin 0.025) wet weight regenerated liver highest group. However, livers appeared pale found be abnormal histologically markedly diminished glycogen amphophylic hepatocyte cytoplasm, their spleens enlarged (by a factor two). The mortality seen whether as bolus daily, continuously part infusate, or not included regimen. next series 70), concentrations, volumes, rates infusion varied. There correlation between caloric (r2 0.831, p 0.0006), glucose 0.598, 0.02), acid 0.619, 0.03) intakes group: at 140 kcal/kg/d, none died; 178 50% 62% 230 80% died. No rat conclusion, hepatectomized fed enterally approximating do well survive. sharp contrast, when identical are infused parenterally. By reducing levels parenterally, survival improves significantly.