术前口服碳水化合物对胃癌术后患者的影响

目的:研究胃癌患者术前口服碳水化合物的安全性及对术后胰岛素抵抗影响。方法:选取胃下部癌病理诊断明确的患者32例,取得知情同意后按照随机双盲的试验,参与者麻醉前2-3小时口服碳水化合物或安慰剂,术前4小时及术后即刻抽取静脉血测定血糖、胰岛素及C-反应蛋白浓度,通过HOMA发计算出术前术后胰岛素抵抗指数、胰岛素敏感指数、胰岛素分泌指数,并将两组进行比较。结果:与口服安慰剂组相比较,术前口服碳水化合物组的血糖、胰岛素、C-反应蛋白及胰岛素抵抗指数更低,且两组患者术后胰岛素敏感性均下降,但口服碳水化合物组的胰岛素敏感性较安慰剂组高。结论:术前2-3小时口服碳水化合物是安全有效的,且能明显术后即刻胰岛素抵抗状态,应作为术前常规处理。

The Impact and Safety of Preoperative Oral Carbohydrate in Radical Diatal Gastrectomy - A Randomized Clinical Trial

Objective: To investigate the safety of preoperative oral carbohydrate and the impact of preoperative oral carbohydrate on postoperative insulin resistance.Methods:32 patients with gastric cancer scheduled were randomly divided into preoperative oral carbohydrate or placebo drink.Preoperative general well-being,2-3 hours before the induction of anaesthesia all patients received either a placebo drink or carbohydrate drink.Blood glucose,insulin,C-reactive protein(CRP) concentration were measured before and immendiately after surgery.Insulin resisstance index was calculated using Homeostasis model assessment(HOMA),and postoperative complications and length of hospital stay were respectively recorded.Results:No complications associated with anaesthesia were recorded as a result of preoperative fluid consumption in the two groups.Blood glucose,insulin,C-reactive protein(CRP) and HOMA-IR immendiately postoperative in the preoperative oral carbohydrate group were significantly lower than those in the preoperative oral placebo group.Insulin sensitivity index(ISI) was reduced in both groups,but was higher in the oral carbohydrate group than oral placebo group.There were no differences between two groups on length of hospital stay.Conclusion:Preoperative consumption of carbohydrate-containing fluid is safe.Preoperative oral carbohydrate may alleviate the postoperative immendiately insulin resistance,and improve the patients clinical outcome.