糖预处理对胃肠道肿瘤手术后胰岛素抵抗及炎性反应的影响  

The effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection

作　　者：刘红磊[1] 马顺茂[2] 任瑞锋[3] 彭艳军 曹斌[2] 

机构地区：[1]河北医科大学附属华北石油管理局总医院物理诊断科,河北任丘062552 [2]河北医科大学附属华北石油管理局总医院普外二科,河北任丘062552 [3]河北医科大学附属华北石油管理局总医院核医学科,河北任丘062552 [4]华北石油二部医院妇产科

出　　处：《中国医师进修杂志》2014年第23期3-5,共3页Chinese Journal of Postgraduates of Medicine

基　　金：基金项目：中国石油华北油田临床医学研究项目（2013-HG-G-19-1）

摘　　要：目的探讨糖预处理对胃肠道肿瘤手术后胰岛素抵抗及炎性反应的影响。方法选取60例择期胃肠道肿瘤手术患者，按随机数字表法分为糖预处理组和对照组，每组30例。糖预处理组术前2h口服含50g葡萄糖的碳水化合物300ml；对照组患者按传统方法进行，术前12h禁食，术前6h禁饮。于术前3h及术后1，3，7d分别抽取患者外周血，检测空腹血糖（FBG）、空腹胰岛素（FINS）、白细胞介素（1L）．6及c反应蛋白（CRP），计算稳态模型评估法胰岛素抵抗指数（HOMA—IR）。结果两组术前3hFBG、FINS、IL-6、CRP及HOMA-IR比较差异无统计学意义（P〉0．05）。两组术后1，3dFBG、FINS、IL-6、CRP及HOMA．IR均明显高于术前3h，而且除FBG外，对照组明显高于糖预处理组[术后第1天：（39．67±10．37）mU/L比（25．78±12．43）mU／L、（98．67±12．42）μg/L比（65．36±16．72）μg／L、（121．74±11．32）mg／L比（82．18±4．36）mg／L、19．07±5．49比11．67±6．32，术后3d：（24．34±6．78）mU／L比（16．23±7．56）mU/L、（116．43±18．57）μG／L比（78．53±10．38）μg／L、（151．30±10．46）mg／L比（129．29±10．24）mg／L、8．56±2．87比5．12±2．11]，差异有统计学意义（P〈0．05）；糖预处理组术后7dFINS及HOMA．IR与术前3h比较差异无统计学意义（P〉0．05），而对照组与术前3h比较差异有统计学意义（P〈0．05）。两组术后7dFBG、IL-6、CRP与术前3h比较差异无统计学意义（P〉0．05）。糖预处理组无一例患者发生麻醉时误吸。结论糖预处理可以缩短胃肠道肿瘤手术后胰岛素抵抗的时间，减轻胰岛素抵抗的强度，改善炎性反应，从而有利于患者的加速康复。Objective To assess the effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection. Methods Sixty patients with elective gastroenteric tumor resection were divided into preoperative carbohydrate preconditioning group and control group by random digits table with 30 cases each. Preoperative carbohydrate preconditioning group was given oral containing 50 g glucose carbohydrate 300 ml 2 h before surgery, and control group was given traditional method, fasting 12 h before surgery and water deprivation 6 h before surgery. The blood samples were collected to measure the level of fasting blood glucose （FBG）, fasting insulin （FINS）,interleukin （IL）-6 and C-reactive protein （CRP）, 3 h before surgery and 1,3,7 d after surgery respectively. Homeostasis model assessment insulin resistance index （HOMA-IR） was computed.Results There were no statistical differences in FBG,FINS,IL-6, CRP and HOMA-IR 3 h before surgery between the 2 groups （P〉 0.05）. The FBG,FINS,IL-6,CRP and HOMA-IR in the 2 groups at 1,3 d after surgery were significantly higher than those 3 h before surgery, but those except for FBG in control group were significantly higher than those in preoperative carbohydrate preconditioning group [ 1 d after surgery： （39.67 ±10.37） mU/L vs. （25.78±12.43） mU/L, （98.67 ±12.42） μg/L vs. （65.36 ±16.72）μg/L, （121.74±11.32） mg/L vs. （82.18±.36） mg/L,19.07 ±.49 vs. 11.67 ±.32;3 d after surgery： （24.34 ±78） mU/L vs. （16.23±.56） mU/L, （116.43±8.57） μg/L vs. （78.53 ±10.38） g/L, （151.30 ±0.46） mg/L vs. （129.29 ±10.24） rag/L,8.56 ±2.87 vs. 5.12 ±2.11],there were statistical differences （P 〈0.05）. There were no statistical differences in FINS and HOMA-IR in preoperative carbohydrate preconditioning group between 7 d after surgery and 3 h before surgery （P 〉 0.05 ）, but there was statistical difference in control group （P �

关 键 词：胃肠肿瘤 糖预处理 胰岛素抵抗 炎性反应 

分 类 号：R735[医药卫生—肿瘤]