术前口服糖类溶液对结肠癌病人术后即时胰岛素抵抗的影响  

The effect of the preoperative oral carbohydrate treatment on immediate postoperative insulin resistance in patients after colorectal cancer resection

作　　者：王治国[1] 秦环龙[1] 

机构地区：[1]上海交通大学附属第六人民医院外科,上海200233

出　　处：《肠外与肠内营养》2008年第6期339-342,共4页Parenteral & Enteral Nutrition

基　　金：上海市卫生科技发展重点项目(200401)

摘　　要：目的:评价术前口服糖类溶液对择期结肠癌病人术后即时胰岛素抵抗的影响。方法:随机将择期结肠癌手术病人32例分为两组,对照组术前常规禁食禁水,试验组在术前3h给予糖类溶液口服。分别在手术前1天15:00和手术当天早晨服药后2h用视觉模拟评分法(VAS)测定两组病人的主观舒适度;在术前4h及术后即刻抽取外周血测定血清葡萄糖和胰岛素浓度,并用稳态模式评估法(HOMA)计算胰岛素抵抗指数、胰岛素分泌指数和胰岛素敏感指数等。结果:术前口服糖类溶液,可明显减轻术前1h的口渴感、饥饿感和焦虑感。对照组术后胰岛素敏感指数下降了38%,而试验组下降了33%(P<0.01)。试验组的胰岛素抵抗程度较对照组改善37%。结论:术前口服糖类溶液安全有效,可改善病人术后即时胰岛素抵抗。Objective ： To operative insulin resistance assess the effect of preoperative carbohydrate fluid intake on immediate post- Methods： 32 patients for elective colorectal cancer resection were recrui- ted to this randomized controlled study. These patients were randomly assigned to control group and test group. Control group were fasted before surgery, while test group were given oral carbohydrate 3 h before surgery. Patient＇S wellbeing scores on a visual analogue scale（VAS） were recorded at 3 PM the day before operation and 2 h after consuming carbohydrate fluid respectively. Blood sample were collected to measure the level of blood glucose and the serum concentrations of insulin 4 h before surgery and immediately after surgery, respectively. Homeostasis model assessment （HOMA） was applied to assess the status of insulin resistance （HOMA-IR）, basic function of pancreatic β cell （HOMA-β cell） and insulin sensitivity index （ISI）. Results： Patients consumed carbohydrate-rich beverage before surgery reduced thirst, hunger and anxiety compared with fasting before surgery. Whole body insulin sensitivity decreased by 33% in the test group vs. 38% in the control group（P 〈 0.01 ）. Treatment with this carbohydrate- rich beverage preoperatively attenuates the postoperative development of insulin resistance by 37%. Conclusion ： Preoperative consumption of carbohydrate-containing fluids is safe and effective. Provision of carbohydrate prior to surgery may attenuate immediate postoperative insulin resistance.

关 键 词：糖类 胰岛素抵抗 结肠癌切除术 择期手术 

分 类 号：R735.35[医药卫生—肿瘤]