@article{oai:niigata-u.repo.nii.ac.jp:00023340,
 author = {吉川, 恵次 and 小林, 孝 and 武藤, 輝一},
 issue = {9},
 journal = {新潟医学会雑誌, 新潟医学会雑誌},
 month = {Sep},
 note = {1. Incidence and clinical characteristics of multiple organ failure (MOF) after gastrectomy : We reviewed retrospectively the records of 241 and 177 patients underwent subtotal gastrectomy (SG) and total gastrectomy (TG: usually with caudal pancreatectomy and splenectomy), respectively, at the Niigata University Hospital during a 5 year period between January 1, 1982 and December 31, 1986. Incidence of the MOF judged according to the modified definition by Mochizuki et al. in SG and TG groups was 0.4 (1/241) and 7.9 (13/177) %, respectively, indicating that magnitude of operative insult is one of the important causative factors. Thirteen of 14 MOF patients (93%) had severe infection (mainly postoperative intra-abdominal infection), according to the definition by Fry et al. The role of postoperative intra-abdominal infection which frequently requires re-operation has to also be emphasized as one of the causative factors. 2. Metabolic and nutritional management in MOF patients after gastrectomy : Almost the same amounts of glucose, amino acids, and fat, consequently, the same amounts of energy and water were given to the patients with MOF, when compared with those in postoperative patients without organ failure. Today, the technique of TPN, hemodialysis, hemofiltration, etc. makes it feasible to provide MOF patients with nutrients of considerable amount. However, whether or not administered nutrients are efficiently used under these conditions is not clear. TPN for the MOF patients has to be further studied. 3. Effects of endotoxin on glucose kinetics : Endogenous glucose production rate (Ra) and glucose disappearance rate (Rd) were increased by the 3mg/kg endotoxin (Et: lipopolysaccharide: E. coli　0127. Difco) injection. Rd became gradually greater than Ra, consequently, hypoglycemia ensued. Glucose oxidation rate (Rox) was significantly increased after Et injection, while % Vco_2 from glucose was increased and % Rd oxidized was unchanged. The results may explain the fact that energy expenditure in MOF patients is maintained or rather increased and may explain the hypoglycemia frequently observed in patients of septic MOF. 4. Topics-Measurement of energy expenditure (EE) of the MOF patients : Importance of the measurement of EE by indirect calorimetry in MOF patients has to be emphasized not only to avoid energy deficit but to avoid providing excess energy, which, recently, proved to have various adverse effects particularly in the hypermetabolic patients.},
 pages = {534--545},
 title = {4) 多臓器障害の代謝と栄養管理 : 特に開腹手術後症例を中心に(シンポジウム 多蔵器障害 : 予防と対策, 第430回新潟医学会)},
 volume = {102},
 year = {1988}
}