术前糖负荷促进胰岛素早相分泌维持围手术期血糖平稳  

Preoperative glucose load can make blood glucose more stable by early stage insulin secretion

作　　者：柳欣欣[1,2] 赵艳[2] 江志伟[1] 陈平[2] 赵伟[2] 王磊[2] 蒋健[2] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002 [2]扬州大学医学院附属江苏省苏北人民医院普通外科,江苏扬州225001

出　　处：《肠外与肠内营养》2012年第3期149-152,共4页Parenteral & Enteral Nutrition

摘　　要：目的:在围手术期营养支持严格热量控制的情况下,观察病人围手术期血糖的变化,并探讨术前糖负荷对围手术期血糖的影响。方法:选择60例择期行结直肠手术的病人,随机分为两组。试验组病人术前给予糖负荷,而对照组则按传统的围手术期方案不给予糖负荷,观察两组病人围手术期的胰岛素分泌状况和血糖变化情况。结果:手术病人于术后血糖均明显升高,至术后第6天仍处于应激性高血糖状态。两组病人手术当天血糖变化曲线存在明显差异,对照组在手术期间无明显胰岛素分泌,并出现明显的应激性高血糖,而试验组在手术期间出现明显的胰岛素分泌,并且血糖保持更为平稳。结论:手术可导致病人出现应激性高血糖,术前给予糖负荷可促进胰岛素早相分泌,有利于围手术期病人的血糖控制。Objective： Under perioperative strict control of the caloric nutritional support,to observe the blood glucose changes after abdominal surgery in non-diabetic patients,and to explore the impact of pre-operative glucose-load.Methods： 60 cases of elective colorectal surgery of non-diabetic patients were randomly assigned into two groups.Experiment group received pre-operative glucose load,while the control group didn＇t receive any glucose.Results： Of all kinds of general surgery patients,postoperative changes of blood glucose increased significantly compared to that of preoperation.Even until the sixth day after surgery,the blood glucose was still in state of high level compared to blood glucose level before operation.The impaired glucose tolerance curves of POD6 was significantly different from that of 2 days before surgery.There was a significant difference of glucose and insulin level between the two groups,at the point of perioperative 24 h.The experiment group which received pre-operative glucose-load maintained more stable in glucose level and more high in insulin level,compared with control group.Conclusion： Surgery can lead to stress related hyperglycemia,while pre-operative glucose-load can make blood glucose more stable by early-stage insulin secretion.

关 键 词：术前糖负荷 应激性高血糖 加速康复外科 胰岛素早相分泌 

分 类 号：R619[医药卫生—外科学]