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Changes in acute phase reactant proteins following thermal injury
W43 MYOCAROIAL
PRESERVATION
BY
MEANS
OF
PREOPERATIVE
ACUTE
PAR-
ENTERAL ALIMENTATION (APA) WITH HIGH INSULIN SUPPLY W. Haider, W. Schiitz, U. Fina, M. Semsroth, C. Staritz. Dept.of Intensive Therapy of the Clinic of Anesthesia and General Intensive Care and the 2nd Surgical Clinic, and Institute of Pharmacology, University of Vienna, Austria The preoperative administration of high doses of insulin together with glucose achieves a shifting of myocardial metabolism towards glycogenesis and glycolysis and a preventive accumulation of the myocardial glycogen stores. Thus the anaerobic availability of energy rich phosphates during &hernia should be increased. 16 patients undergoing mitral valve replacement were investigated in 2 randomized groups. While one group received an insulin supply of 1 U/kg/h together with glucose (0.5 g/kg/h) from the onset on anesthesia until the aortic clamping, the other group served as control receiving ringerlactate with the same infusion speed. After an average time of 26 min ischemia the energy rich phosphates from a cut-out paoillarv-muscle-tip were determined. The mean ATP-content of the myocardium in the insulin ‘group was 7.98Fmol/g wet weight and significantly hiqher ( p 0.01) than that of the control qroup (4.541rmol/g). The mean ADPcontent was 30 % lower in the insulin group. The mean CP $creatin phosphate)content was also significantly (p 0.05) higher in the insulin group (6.78,#nol/g) in relation to the control group (5.16flol/g). Also the mean ATP/ADP-quotient (insulin group: 5.53 versus control group: 2.61) as well as the mean ECP (energy charge potential) (insulin group: 0.919 versus control group: 0.857) were significantly (p 0.01) higher in the insulin group. Thus the preoperative high insulin supply together with glucose leads to a better energy provision of the myocardium during the hypoxia and represents an improved myocardial protection.
W44
CHANGES IN ACUTE PHASE REACTANT PROTEINS FOLLOWING THERMAL INJURY G.F. Batstone, P.G. Shakespeare, P.G. Levick, 8.3. Moody. Dept.of Chemical Patholoqy and Regional Burn Centre, General Infirmary, Salisbury, Wiltshire, Great Britain Serum levels of the acute phase reactant proteins, antitrypsin (&AT),U@ntichymotryspin (rr,ACT), transferrin CT), retinol binding protein (RBP), thyroxine binding prealbumin (TBPA) and albumin (A) were measured for 21 days following burn injury. Patients were divided into two groups by a predictive index of burn mortality - a severe group (GI) with a mean predicted mortality of 30% and a mild arouo (GII) with one of less than 5%. Values of&, AT were siqnificantlv greater
104
PRESERVATION
BY
MEANS
OF
PREOPERATIVE
ACUTE
PAR-
ENTERAL ALIMENTATION (APA) WITH HIGH INSULIN SUPPLY W. Haider, W. Schiitz, U. Fina, M. Semsroth, C. Staritz. Dept.of Intensive Therapy of the Clinic of Anesthesia and General Intensive Care and the 2nd Surgical Clinic, and Institute of Pharmacology, University of Vienna, Austria The preoperative administration of high doses of insulin together with glucose achieves a shifting of myocardial metabolism towards glycogenesis and glycolysis and a preventive accumulation of the myocardial glycogen stores. Thus the anaerobic availability of energy rich phosphates during &hernia should be increased. 16 patients undergoing mitral valve replacement were investigated in 2 randomized groups. While one group received an insulin supply of 1 U/kg/h together with glucose (0.5 g/kg/h) from the onset on anesthesia until the aortic clamping, the other group served as control receiving ringerlactate with the same infusion speed. After an average time of 26 min ischemia the energy rich phosphates from a cut-out paoillarv-muscle-tip were determined. The mean ATP-content of the myocardium in the insulin ‘group was 7.98Fmol/g wet weight and significantly hiqher ( p 0.01) than that of the control qroup (4.541rmol/g). The mean ADPcontent was 30 % lower in the insulin group. The mean CP $creatin phosphate)content was also significantly (p 0.05) higher in the insulin group (6.78,#nol/g) in relation to the control group (5.16flol/g). Also the mean ATP/ADP-quotient (insulin group: 5.53 versus control group: 2.61) as well as the mean ECP (energy charge potential) (insulin group: 0.919 versus control group: 0.857) were significantly (p 0.01) higher in the insulin group. Thus the preoperative high insulin supply together with glucose leads to a better energy provision of the myocardium during the hypoxia and represents an improved myocardial protection.
W44
CHANGES IN ACUTE PHASE REACTANT PROTEINS FOLLOWING THERMAL INJURY G.F. Batstone, P.G. Shakespeare, P.G. Levick, 8.3. Moody. Dept.of Chemical Patholoqy and Regional Burn Centre, General Infirmary, Salisbury, Wiltshire, Great Britain Serum levels of the acute phase reactant proteins, antitrypsin (&AT),U@ntichymotryspin (rr,ACT), transferrin CT), retinol binding protein (RBP), thyroxine binding prealbumin (TBPA) and albumin (A) were measured for 21 days following burn injury. Patients were divided into two groups by a predictive index of burn mortality - a severe group (GI) with a mean predicted mortality of 30% and a mild arouo (GII) with one of less than 5%. Values of&, AT were siqnificantlv greater
104