The Relation Of Resting Energy Expenditure, Visceral Proteins And Intestinal Permeability In Patients Undergoing Middling To Severe Stress Surgery Of General Surgery

Objective To explore the relationship of resting energy expenditure (REE), visceral proteins and intestinal permeability (IP) on patients undergoing middling to severe stress surgery in general surgery.Methods 25 patients had been studied from August 2006 to March 2007, which were performed middling or larger operations in Dept. of General Surgery, Affiliated Hospital of Qingdao University Medical College. REE, visceral proteins and IP were measured on the second day, seventh day after operation and on the day just before operation. The outcome was analysed with Statistical Package for the Social Science 13.0 for Windows.Results Patients' REE on the second day ,the seventh day postoperation and the preoperative day were 1226.25±53.19 Kcal, 1464.81±47.48 Kcal and 1217.75±55.09Kcal in male, and 1193.13±56.68Kcal, 1406.00±42.07Kcal and 1177.63±68.40Kcal in female respectively. There were significant differences between REE on the second day and on the seventh day (p＜0.05). No significant differences was found for that of the seventh day postoperation and that of the day before operation (p＞0.05). The concentrations of albumin (ALB), prealbumin (PA), transferring (TRF), retinol binding protein (RBP) and hypersensitve C-reactive protein (hs-CRP)were 34.99±5.77g/L, 0.27±0.09 g/L, 0.04±0.02 g/L, 2.58±0.47 g/L and 3.01±2.56mg/L respectively brfore the preoperative day. They were 28.62±4.47 g/L, 0.14±0.03 g/L, 0.02±0.01 g/L, 1.93±0.32 g/Land 87.43±41.40 mg/L respectively on second day postoperation and the their concentrations were 29.94±4.67 g/L, 0.22±0.06 g/L, 0.04±0.02 g/L, 2.41±0.76 g/L and 29.47±18.86 mg/L respectively on the seventh day postoperation. It showed that there were significant differences between all the outcome measured on the second day postoperation with that of the preoperative day. All the measures on the seventh day after operation had no significant differences with that of the preoperative day, except for lower concentration of ALB and higher concentration of hs-CRP. The ratios of Lactulose to Mannitol on the second postoperative day, the seventh day after operation and the preoperative day were 0.054±0.040, 0.226±0.205 and 0.116±0.130 respectively. There were significant differences among the ratio of Lactulose to Mannitol on second day, seventh day postoperation and the preoperative day when comparing them each other. The relativities were analysed among the aterations of ratio of Lactulose to Mannitol, among the aterations of concentions of visceral proteins, hypersensitve C-reactive protein and resting energy expenditure. It can be inferred that the changes of ratio of Lactulose to Mannitol was correlated with the alterations of PA, TRF, retinol binding protein and hs-CRP.Conclusion Middling or larger surgeries have great effect on patient's REE, visceral proteins, hs-CRP and IE REE, hs-CRP and IP increased significantly and the visceral proteins decreased significantly after operation . With the ceasing of the stress cause, REE, PA, TRF, retinol binding protein return to the preoperative level, except for lower concentration of ALB, higher concentration of hs-CRP and higher ratio of Lactulose to Mannitol in the seventhday postoperation. The alteration of ratio of Lactulose to Mannitol was correlated negatively with the concentration changes of PA, TRF, retinol binding protein and hs-CRP.