0.17 SUBARACHNOIDAL HEMORRHAGE, ITS SURGICAL TREATMENT AND PERIOPERATIVE CORTICOID TREATMENT IMPAIR NITROGEN UTILIZATION

Hersio K., Vapalahti M., Luukkonen M., Kari A., Takala J., Hernesniemi J., Tapaninaho A. Departments of Anesthesiology, Intensive Care and Neurosurgery , Critical Care Research Program, Kuopio University Central Hospital, Kuopio Finland

We studied the metabolic response to surgery after acute subarachnoidal hemorrhage (SAH), and its modification by parenteral nutrition. 31 patients receiving corticoids (Gluc+C , CAA+G+C) and 20 similar patients, who did not receive corticoids (Glut, CAA+G) , were randomly assigned to receive for two days : either glucose alone (7.2 kcal/ka/dav. Gluc+C, Glut) or glucose with balanced amino acid (0.15 g.u/kg/&y CAA+G+C, was similar in all

CAA+G). The neurosurgical status (Glascow coma score) groups during the study.

RESULTS(means+SD): -__- Group Glut (n=ll) Gluc+C (n=16) CAA+G (n=9) CAA+G+C (n=15)

N-excretion(g/day) N-balance(g/day) Day1 Day2 Day1 Day2

*10.6+3.4 X6.8+4 -10.1+3.6 -7.7+4.8 14.159.3 11.6T5.3 **-14.959 -12.555.3

*18.8T8.4 *17.6+6.2 -7.7T6.5 -7.8+6 22.5T8.5 20.5E11.9 -12.8T7.8 -11.6+10.5 - _

*Glut vs Gluc+C, CAA+G vs CAA+G+C, pt0.05, _

MANOVA ** Gluc+C vs CAA, p<O.O5, MANOVA Conclusions : 1. SAH and its surgical treatment induce a moderate catabolic response. 2. Utilization of exogenous nitrogen is impaired; only 10-20 % of infused nitrogen is retained. 3. Corticosteroids increase the net protein loss and further impair the utilization of exogenous nitrogen.

0.18 EFFICACY OF PREOPERATIVE TOTAL PARENTERAL NUTRITION(TPN) IN NEOPLASTIC VERSUS NON NEO- PLASTIC PATIENTS. S.Celaya, V.Palacios, M.Nnvnrro, L.Lnrrnd, A.Ron& ,?lP. Losierra , R.Lozano . University and Miguel Servet Hospital. ZAXAGOZA-SPAIN

The aim of present study is to compare the resultsofpreoparntive TPNin naoplastic versus non neoplastic patients before gastrointestinal surgery.

25 malnourished patients before underwent gastrointestinal surgery(l2 neoplastic,l3 non neoplastic),l4 male and 11 femnle.Age 53+7 years,received TPN during 7 days(0.25 gr N/kg and day;130 cal./gr N(40% from lipids)).ie have studied plaometic levels ofAlbumin,Trans- ferrin,Prealbumin,Retinol binding protein,Cholesterol and lymphocyte subpopulntions(CD4, CDs) before and after TPN. Student'test has been used as statistical method.

NEOI'LASTIC NON NEOPLASTIC PRE POST TPN PRE POST TPN

ALBUMIN 2.96kO.6 3.230.7 3.6+0.7 3.4+0.9

TRASFERRIN 140135 159i60 161+31 -

193+65 *

PREALBUMIN 12 . w-4 14.M7 13.2+6 19.5iS **

R.B.P. 2.631.2 2.9+1.5 2.7+0.4 4.1950.7 *

CHOLESTEROL 134+26 161338 * 119+29 133+;2

T-HELPER % 33.720.1 42.&1.3 * 30.3+0.1 - 42.7-jl.S *

:>(pcO.O5) **(p<o.ol)

CONCLUSIONS l)-Administration of preoperative TPN during 7 days is able to improve vise- cernl proteins(Transferrin,Prealbumin,R.S.P.) in malnourished non neoplastic patients, whereas in neoplastic improves cholesterol levels. 2)-In both groups sinilar lmprova 0: lymphocyte subpopulations have been observed. 3)-Peripheral blood percentage of T- helper cells may be an early parameter to measure the T?N effect.

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