术前口服碳水化合物对胃肠道肿瘤手术后胰岛素抵抗及应激反应的研究  

Study on the insulin resistance and stress response by preoperative oral carbohydrate for patients with gastrointestinal cancer after surgery

作　　者：秦薇[1] 江烂林[1] 张丰[1] 王磊[1] 钱惠玉[1] 沈江[1] 

机构地区：[1]江苏省常州市第一人民医院,江苏常州213003

出　　处：《护士进修杂志》2017年第23期2119-2122,共4页Journal of Nurses Training

摘　　要：目的探讨术前口服碳水化合物对胃肠道肿瘤手术后胰岛素抵抗及应激反应的影响。方法将2016年7月-12月择期行胃肠道肿瘤手术的77例患者按随机数字表法随机分为两组。观察组(38例)患者术前晚、术晨分别口服碳水化合物溶液500mL、250mL。对照组(39例)患者术前晚、术晨分别口服蒸馏水500mL、250mL。比较两组患者麻醉反流或误吸的次数;手术前后血糖浓度、胰岛素浓度和稳态模式的胰岛素抵抗指数(HOMA-IR)及C反应蛋白(CRP)的变化;术后并发症、手术时间、术中出血量、住院天数。结果两组患者在麻醉诱导插管或拔管时均未发生反流或误吸。术后第1天观察组胰岛素浓度(8.1±2.8)mU/L、HOMA-IR(2.7±1.1)及CRP(43.5±25.2)低于对照组(13.1±2.7、4.6±1.1、60.6±25.8)(P<0.01)。术后第3天观察组CRP(64.3±35.7)低于对照组(85.8±43.8)(P<0.05)。两组患者在术后并发症、手术时间、术中出血量、住院天数方面差异无统计学意义(P>0.05)。结论缩短术前禁食禁饮时间并口服碳水化合物溶液不会增加麻醉风险,而且可减轻胃肠道肿瘤手术后胰岛素抵抗,并改善机体应激反应,促进机体快速康复。Objective To investigate the effect of preoperative oral intake carbohydrate on postoperative insulin resistance and stress response for patients with gastrointestinal tumor.Methods 77 patients undergoing elective surgery for gastrointestinal tumor from July to December 2016 were randomly divided into two groups by random number table method.Patients in observation group（38 cases）was treated with carbohydrate solution 500 mL and250 mL before operation in the morning.The control group（39 cases）were treated with distilled water 500 mL and250 mL before operation in the morning.The patients with anesthesia regurgitation or aspiration number of times,changes of blood glucose concentration,insulin concentration and homeostasis model assessment of insulin resistance（HOMA-IR）and C-reactive protein（CRP）levels was measured and compared before and after operation of two group.Postoperative complications,operative time,intra-operative blood loss and length of hospital stay was compared.Results The anesthesia induction intubation or extubation for two groups of patients did not occur regurgitation or aspiration.On the first day after operation,the insulin concentration（8.1±2.8）,HOMA-IR（2.7±1.1）and CRP（43.5±25.2）of the observation group were significantly lower than that of the control group（13.1±2.7,4.6±1.1,60.6±25.8）（P〈0.01）.On the third day after operation,the CRP（64.3±35.7）of the observation group was significant ly lower than that of the control group（85.8±43.8）（P〈0.05）.There was no significant difference in postoperative complications,operation time,intra-operative blood loss,length of hospital stay between the two groups（P〉0.05）.Conclusion Shortening preoperative fasting time and oral carbohydrate solution will not increase the risk of anesthesia,but also can reduce the gastrointestinal tumor after surgery insulin resistance,and improve the body’s stress response,promote rapid recovery.

关 键 词：碳水化合物 胃肠道肿瘤 胰岛素抵抗 C反应蛋白 血糖 胰岛素 

分 类 号：R473.73[医药卫生—护理学] R735[医药卫生—临床医学]