术前口服葡萄糖溶液对胃肠术后胰岛素抵抗及炎症反应的影响  

Preoperative oral carbohydrate alleviates postoperative insulin resistance and inflammatory reaction

作　　者：曹战江[1] 于健春[1] 康维明[1] 马志强[1] 叶欣[1] 孟庆彬[1] 田树波[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院基本外科,100730

出　　处：《中华内分泌外科杂志》2015年第4期305-308,共4页Chinese Journal of Endocrine Surgery

基　　金：中央保健专项资金科研课题（B2009A094）;中国医学科学院北京协和医院青年基金（2009123）;卫生部内分泌重点实验室基金（2009301）

摘　　要：目的观察术前口服葡萄糖溶液对胃肠手术后血糖、胰岛素抵抗（insulin resistance，IR）及炎症反应的影响。方法48例胃肠手术采用区组随机法随机分为研究组23例及对照组25例。研究组术前3h前口服25％葡萄糖溶液300ml，比较2组术前胃内容物量、pH值及术后第1天的血清高敏c反应蛋白（high sensitivity C—reactive protein，hsCRP）、空腹血糖、胰岛素水平、胰岛素抵抗指数稳态模型（homeostasis model assessment—insulin resistance，HOMA—IR）。结果2组均无麻醉及手术并发症。麻醉前2组胃内容物量、pH值差异无统计学意义；术前2组hsCRP、血糖、胰岛素水平、HOMA—IR差异无统计学意义。术后第1天研究组空腹血糖、HOMA．IR及hsCRP均明显低于对照组（6．51±1．15VS7．49±0．57mmol／L，P=0．038），（4．34±1．60VS6．09±2．81，P=0．043），（40．45±27．02vs80．02±38．98mg／L，P=0．03），差异有统计学意义。结论术前口服葡萄糖溶液可明显改善患者术后血糖及IR，减轻术后炎症反应。Objective To observe the effect of preoperative oral administration of carbohydrate on blood glucose, insulin resistance（IR） and inflammatory reaction after gastrointestinal operation. Methods 48 patients receiving gastrointestinal operation were randomly divided into the study group（ n = 23 ）and the control group（ n = 25 ）. Patients in the study group were orally given 25% glucose solution 300 ml 3 hours before operation. Before anesthesia induction, gastric contents were aspirated through nasogastric tube to examine its volume and pH. Ser- um high sensitivity C-reactive protein （hsCRP）, fasting blood glucose, insulin level and homeostasis model as- sessment-insulin resistance（HOMA-IR） were detected before operation and on the first morning after operation be- tween the two groups. Results No anesthesia or operation related complications occurred in either groups. Pa- tients had similar gastric contents volume and the PH value of gastric contents. There was no significant difference in serum hsCRP, fasting blood glucose and HOMA-IR between the two groups before operation. But on the first day, fasting blood glucose, HOMA-IR and hsCRP were significantly lower in the study group than in the control group（6. 51 ±1.15 vs 7.49 ±0.57 mmol/L, P =0.038; 4.34 ± 1.60 vs 6.09±2.81, P =0.043; 40.45± 27.02 vs 80. 02 2 38.98 mg/L, P = 0. 03 ）. Conclusion Preoperative oral administration of carbohydrate can obviously lower the postoperative blood glucose level and insulin resistance and alleviate postoperative inflammato- ry reaction.

关 键 词：口服葡萄糖溶液 胰岛素抵抗 炎症反应 

分 类 号：R656[医药卫生—外科学]