术前口服碳水化合物对老年2型糖尿病患者关节置换术后胰岛素抵抗及围术期安全性的影响  

Effect of preoperative oral carbohydrate intake on insulin resistance and perioperative safety in elderly patients with diabetes mellitus type 2(T2DM)after joint replacement

作　　者：闫美霞 刘自双 侯璐 张娜[1] 李国庆 YAN Meixia;LIU Zishuang;HOU Lu;ZHANG Na;LI Guoqing(Elderly Rehabilitation Center,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 10000,China)

机构地区：[1]首都医科大学附属北京康复医院老年康复中心,北京10000

出　　处：《新疆医科大学学报》2024年第5期755-760,764,共7页Journal of Xinjiang Medical University

基　　金：北京市科技计划项目(D21500030688001)。

摘　　要：目的探讨术前口服碳水化合物对老年2型糖尿病合并高感染风险的骨科手术患者术后胰岛素抵抗及围术期安全性的影响。方法选择2021年9月至2023年9月首都医科大学附属北京康复医院收治的90例行关节置换的老年患者为研究对象,采用随机数字表法,将患者分为对照组(NC组),口服碳水化合物(OC)1组和2组,每组30例患者,3组患者术前2 h分别服用0、100、200 mL碳水化合物饮品(素乾),比较3组患者胃容积相关指标、生命体征指标、胰岛素抵抗相关指标及临床症状评分的差异。结果(1)在手术开始1 h后,OC2组患者的平均动脉压(MAP)明显低于NC组及OC1组(P<0.05),在手术开始1 h及拔除气管导管时,OC2组患者的脑电双频指数均显著高于NC组及OC1组(P<0.05)。(2)在麻醉诱导前、麻醉苏醒、次日晨等3个时间点,与NC组及OC1组相比,OC2组患者白蛋白水平显著较高(P<0.05),促肾上腺皮质激素(ACTH)水平明显较低(P<0.05)。与NC组相比,OC1组及OC2组患者空腹胰岛素(FINS)及胰岛素抵抗指数(HOMA-IR)逐渐下降(P<0.05)。(3)术后24 h,与NC组相比,OC1组及OC2组患者焦虑、抑郁、饥饿、口渴、疼痛、恶心、乏力等症状评分显著较低(P<0.05)。(4)与NC组患者相比,OC1组及OC2组患者术后恶心、呕吐及感染的发生率较低(P<0.05),术后首次排气时间较短(P<0.05)。结论老年患者关节置换术前2 h口服200 mL碳水化合物可维持正常的血糖浓度,减轻围术期胰岛素抵抗,同时减轻患者术后症状。Objective To investigate the effect of preoperative oral carbohydrate on insulin resistance and perioperative safety in elderly patients with diabetes mellitus type 2(T2DM)complicated with high infection risk undergoing orthopedic surgery.Methods 90 elderly patients with joint replacement admitted to the hospitalfrom September 2021 to September 2023 were selected as the research subjects.Using a ran-dom number table method,the patients were divided into a control group(NC group),an oral carbohydrate(OC)group 1 and an OC2 group,with 30 patients in each group.3 groups of the patients took 0,100 and 200 mL of carbohydrate drinks(Suqian)2 hours before the surgery,and the differences in gastric volume related indicators,vital signs indicators,insulin resistance related indicatorsand clinical symptom scores among the 3 groups were compared.Result(1)After 1 hour of the surgery,the mean arterial pressure(MAP)of the patients in the OC2 group was significantly lower than that in the NC group and OC1 group(P<0.05).At 1 hour of the surgery and when the tracheal duct was removed,the bispectral index of EEG in the OC2 group was significantly higher than that in the NC group and OC1 group(P<0.05).(2)At 3 time points before anesthesia induction,anesthesia awakening,and the next morning,compared with the NC group and OC1 group,the OC2 group had significantly higher albumin levels(P<0.05)and significantly lower levels of adrenocorticotropic hormone(ACTH)(P<0.05).Compared with NC group,the fasting insulin(FINS)and insulin resistance index(HOMA-IR)of the patients in the OC1 and OC2 groups was gradually decreased(P<0.05).(3)24 hours after the surgery,compared with the NC group,the patients in the OC1 and OC2 groups had significantly lower scores for symptoms such as anxiety,depression,hunger,thirst,pain,nausea and fatigue.The differences between the 2 groups were statistically significant(P<0.05).(4)Compared with the NC group patients,the incidence of postoperative nausea,vomiting,and infection in the OC1 and OC2 groups was lower(P<0

关 键 词：碳水化合物 糖尿病 胰岛素抵抗 感染 

分 类 号：R587.1[医药卫生—内分泌]