术前口服碳水化合物对胸部肿瘤外科患者围术期应激和代谢变化的改善  

Preoperative Oral Carbohydrate Administration Can Ameliorate Perioperative Stress and Metabolism for Patients with Surgical Thoracic Oncology

作　　者：张利民[1,2] 康晓征[1,2] 陈冀衡[1,3] 范志毅[1,3] 杨志[1,4] 申潞艳[1,2] 陈克能[1,2] 

机构地区：[1]北京大学肿瘤医院 [2]北京市肿瘤防治研究所胸外一科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [3]北京市肿瘤防治研究所麻醉科,北京100142 [4]北京市肿瘤防治研究所核医学科,北京100142

出　　处：《中国胸心血管外科临床杂志》2012年第5期463-467,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：秦惠君-李政道中国大学生科研见习进修项目基金(兰州大学);国家重点基础研究发展计划(973计划;2011CB504300);国家自然科学基金资助项目(30572130);北京市自然科学基金资助项目(7102029);首都医学发展科研基金(2007-1023);北京市卫生系统高层次卫生技术人才培养计划(2009-2-17)~~

摘　　要：目的探讨术前口服碳水化合物(CHO)对胸部肿瘤外科患者围术期风险的影响,为制订科学的术前禁食、禁水策略提供理论依据。方法前瞻性收集2010年7～9月期间北京大学肿瘤医院胸外一科收治的胸部肿瘤外科患者32例(从总共65例患者中筛选出),入组患者按随机数字表法分为两组,试验组:术前1 d晚餐后通宵禁食,麻醉诱导前2 h口服12.5%的葡萄糖溶液400 ml;对照组:术前1 d晚餐后禁食,午夜开始禁水。研究两组主观症状(口渴和饥饿)的视觉模拟评分(VAS)、血糖、血清胰岛素、胰岛素抵抗(HOMA-IR)、术后住院时间及术后并发症等指标。结果试验组与对照组各16例患者入组。试验组患者麻醉诱导前1 h口渴和饥饿的VAS评分均低于对照组(24 vs.49,24 vs.62,P=0.000);试验组患者麻醉诱导前血糖[(8.59±0.43)mmol/L vs.(5.59±0.43)mmol/L,P=0.000]、血清胰岛素[(24.33±1.80)mIU/ml vs(.16.28±1.80)mIU/ml,P=0.004]、HOMA-IR(9.23±0.77 vs.4.03±0.77,P=0.000)均高于对照组,差异均有统计学意义,并且试验组患者的3项指标术后均较快地降至基线水平;两组患者术后住院时间和并发症发生率差异均无统计学意义(P>0.05)。结论麻醉诱导前2 h口服CHO对胸部肿瘤外科患者是安全的,并可缓解患者围手术期的主观不适,同时降低胰岛素抵抗,改善患者的应激与代谢状态。Objective To investigate the effect of preoperative oral carbohydrate（CHO） administration on perioperative risks of patients with surgical thoracic oncology,and provide evidence for establishing new scientific preoperative fasting strategy.Methods In this prospective study,from July to September 2010,32 out of 65 enrolled patients with surgical thoracic oncology in Department 1 of Thoracic Surgery,Cancer Hospital of Peking University,were randomly allocated to preoperative experiment group（fasting overnight and oral 12.5% dextrose 400 ml administration 2 h before anesthesia induction） or control group（fasting overnight and water deprivation from midnight）.Clinical data were collected including subjective evaluation of thirst and hunger measured by visual analogue scale（VAS）,blood glucose level（BGL）,serum insulin level,homeostasis model assessment insulin resistance（HOMA-IR）,postoperative length of hospital stay（LOS） and complications.Results Sixteen patients were enrolled in each group.VAS scores of thirst and hunger of the preoperative experiment group at 1 h before anesthesia induction were significantly lower than those of the control group（24 vs.49,24 vs.62,P=0.000）.BGL（8.59±0.43 mmol/L vs.5.59±0.43 mmol/L,P=0.000）,serum insulin level（24.33±1.80 mIU/ ml vs.16.28±1.80 mIU/ml,P=0.004）and HOMA-IR（9.23±0.77 vs.4.03±0.77,P=0.000）of the preoperative experiment group before anesthesia induction were significantly higher than those of the control group,and these three variables of the preoperative experiment group returned to baseline level soon after surgery.There was no statistical difference in postoperative LOS and complication rate between the two groups（P0.05）.Conclusion Preoperative oral CHO treatment is safe for non-diabetic patients with surgical thoracic oncology,can alleviate their subjective discomfort,decrease insulin resistance,and ameliorate their perioperative stress and metabolism.

关 键 词：碳水化合物 胸部肿瘤 外科手术 胰岛素抵抗 应激 代谢 

分 类 号：R730.5[医药卫生—肿瘤]