糖预处理对胃肠道肿瘤手术后胰岛素抵抗及免疫功能的影响  

The effect of preoperative carbohydrate administration on postoperative insulin resistance and immune function in patients after gastroenteric tumor resection

作　　者：马顺茂[1] 冯增利[1] 刘红磊[2] 任瑞锋[3] 陈咏梅 于哲[5] 

机构地区：[1]河北医科大学附属华北石油管理局总医院普外二科,河北省任丘062552 [2]河北医科大学附属华北石油管理局总医院物理诊断科,河北省任丘062552 [3]河北医科大学附属华北石油管理局总医院核医学科,河北省任丘062552 [4]华北石油采一社区卫生服务中心 [5]河北医科大学附属华北石油管理局总医院心胸外科,河北省任丘062552

出　　处：《中国医师杂志》2014年第11期1491-1493,1497,共4页Journal of Chinese Physician

基　　金：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免疫功能的影响.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治疗组和对照组各30例.治疗组术前给予糖预处理及新的禁食水方法,即麻醉前6h禁食2h禁水,麻醉前2h口服含50 g葡萄糖的碳水化合物300 ml;对照组患者按传统方法进行,术前12 h禁食,术前6h禁水.于术前3h、术后第1、3、7天分别抽取患者外周血,定量监测空腹血糖（FBG）、空腹胰岛素（FINS）,采用稳态模型法计算胰岛素抵抗指数（HOMA-IR）评估患者胰岛素抵抗情况,检测细胞免疫功能指标CD3^＋、CD4^＋、CD8^＋及CD4^＋/CD8^＋比值评估患者免疫功能情况.结果 术后第1天两组HOMA-IR明显高于术前,CD4^＋、CD4^＋/CD8^＋比值均低于术前,差异有统计学意义（P＜0.05）;术后第1、3天治疗组HOMA-IR明显低于对照组,CD4^＋、CD4^＋/CD8^＋比值高于对照组,差异有统计学意义（P＜0.05）;术后第7天治疗组HOMA-IR接近术前,差异无统计学意义（P＞0.05）,而对照组仍高于术前,差异有统计学意义（P＜0.05）.术后第7天两组CD4^＋、CD4^＋/CD8^＋比值水平均接近于术前,差异无统计学意义（P＞0.05）.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,改善免疫功能,从而有利于患者的康复.Objective To investigate the effect of preoperative carbohydrate fluid intake on postoperative insulin resistance and immune function.Methods Sixty elective gastroenteric tumor resection patients were randomly divided into test （n =30） and control （n =30） groups.Control group were fasted before surgery,while test group were given oral carbohydrate before surgery.The blood samples were collected to measure the levels of fasting blood glucose （FBG）,fasting insulin （FINS）,and cellular immunity （CD3^＋,CD4^＋,CD8^＋,and CD4^＋/CD8^＋） before operation and 1,3,7 day postoperation,respectively.Homeostasis model assessment （HOMA） was applied to assess the status of insulin resistance.Results Compared to preoperation,the levels of CD4^＋,CD4^＋ / CD8^＋,and HOMA-IR at 1 day postoperation in both control and test groups were significantly higher （P 〈 0.05）.Compared to test group,the levels of CD4^＋,CD4^＋/CD8^＋,and HOMA-IR at 1,3 day postoperation in control group were significantly higher （P 〈 0.05）.At the seventh day after surgery,HOMA-IR levels in the test group were returned to the preoperative level （P 〉 0.05）,while the control group was still higher than before surgery （P 〈 0.05）.There were no differences in CD4^＋ and CD4^＋/CD8^＋ at seventh days after surgery between two groups （P 〉 0.05）.Conclusions Preoperative carbohydrate administration may shorten the insulin resistance duration after gastrointestinal cancer surgery,reduce the intensity of insulin resistance,and improve immune function.Thus contributes to the rehabilitation of patients.

关 键 词：胃肠肿瘤/外科学 胃肠肿瘤/免疫学 禁食 手术后并发症/预防和控制 胰岛素抗药性 

分 类 号：R735[医药卫生—肿瘤]