GLUCOSE-XYLITOL 35-PERCENT (1 1) VERSUS G LUCOSE 40-PERCENT - EFFICACY AND METABOLIC EFFECTS AFTER MAJOR SURGERY/

Injury and stress are accompanied by a characteristic hormonal respons e and altered energy utilisation. Hyperglycaemia and negative nitrogen (N) balance are the leading symptoms of the metabolic changes in the post-operative state. In a prospective, randomised study the efficacy and metabolic effects of glucose-xylitol (GX) 35% (1:1) versus glucose (G) 40% were investigated in patients undergoing major surgery. Metho d. Twenty-four patients undergoing abdomino-thoracic oesophageal cance r surgery were treated in a standardised manner. Total parenteral nutr ition was administered over 6 days (kg body wt.-1/day): day of surgery 1-1.25 g carbohydrate (CH); 1st postoperative day (POD) 1.5 g CH, 1 g amino acids (AA); 2nd POD 3 g CH, 1.5 g AA, 1.0 g fat; from 3rd POD 3 g CH, 1.5 g AA, 1.5 g fat (CH GX35% (n = 12) or G40% (n = 12), AA Int rafusin 15%, fat Intralipid 20%). Daily and cumulative N balances, blo od-G profiles, blood chemistry, and physical parameters were determine d. Glucagon and insulin profiles, CH losses, and oxalic acid secretion were measured. Results. Both groups were comparable for age, body mas s index, clinical and physical parameters, and blood chemistry. Mean c umulative N balances after 6 days were - 12.0 +/- 16.3 g N for GX35% a nd - 5.6 +/- 19.4 g N for G40% (n.s.; Wilcoxon, P < 0.05). Blood G was similar for both groups with values ranging from 130 to 240 mg/dl on the day of surgery and below 150 mg/dl on the consecutive days. In eac h group 1 patient needed additional insulin therapy. Glucagon and insu lin levels did not show a significant difference between the groups. C onclusion. No difference in tolerance and efficacy of nutritional supp ort by GX versus G at a dose of 3 g.kg body wt.-1.d in oesophagectomis ed patients could be observed. Similar blood G profiles were in accord ance with comparable glucagon and insulin levels. Because of the high standard deviations of N balances, differences in efficacy could not b e proven. A significantly lower level of pseudocholinesterase (PCHE) f or G40% on day 7 might indicate enhanced hepatic protein synthesis in the GX group.