术前口服不同剂量碳水化合物溶液对腹腔镜胆囊切除术患者胰岛素抵抗的影响  

Effect of preoperative different oral doses of carbohydrate solution on insulin resistance in patients undergoing laparoscopic cholecystectomy

作　　者：王萧晗 程建鑫 盛婧祎 郭珊珊 王蕊 王志萍 Wang Xiaohan;Cheng Jianxin;Sheng Jingyi;Guo Shanshan;Wang Rui;Wang Zhiping(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Jiangsu Province Key Lab-oratory of Anesthesiology,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology,NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院麻醉科,徐州221002 [2]徐州医科大学江苏省麻醉学重点实验室,江苏省麻醉与镇痛应用技术重点实验室,国家药品监督管理局麻醉精神药物研究与评价重点实验室,徐州221004

出　　处：《国际麻醉学与复苏杂志》2024年第9期923-928,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82270059);江苏省自然科学基金(BK20221222);中国初级卫生保健基金会项目(YLGX‑MZ‑2022004)。

摘　　要：目的评价术前2~4 h口服不同剂量碳水化合物溶液(枢能)对腹腔镜胆囊切除术(LC)患者胰岛素抵抗(IR)的影响。方法选择全身麻醉下择期行LC手术的患者150例,年龄18~65岁,美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,体重指数(BMI)18~30 kg/m2,采用随机数字表法将患者分为3组(每组50例):空腹对照组(C组)、口服200 ml枢能组(P1组)和口服400 ml枢能组(P2组)。3组患者均于术前1晚22点禁食、24点禁饮,P1组和P2组于术前2~4 h分别口服枢能200 ml和400 ml,C组不饮用任何液体。记录患者一般资料;于麻醉诱导前10 min(T1)和拔管后10 min(T2)测定空腹血糖(FG)和空腹胰岛素(FINS)浓度,通过稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)和胰岛素敏感性指数(HOMA-ISI);于T1时通过床旁胃超声测量患者右侧卧位下胃窦横截面积(CSA),评估胃容量(GV)、胃容量体重比值(GV/W)、GV/W>1.5 ml/kg的发生情况和Perlas分级,观察反流误吸发生情况;记录T1、T2时患者饥饿、口渴和焦虑的视觉模拟评分法(VAS)评分;记录入室(t1)、麻醉诱导(t2)、切皮(t3)、气腹(t4)和撤腹腔镜(t5)时患者的平均动脉压(MAP)和心率变化。结果3组患者一般资料差异均无统计学意义(均P>0.05)。T1时C组患者血糖水平低于P2组(P<0.05);与T1时比较,T2时C组患者血糖水平较高(P<0.05),3组患者胰岛素水平、HOMA-IR及HOMA-ISI均较低(均P<0.05);T1、T2时3组患者胰岛素水平、HOMA-IR及HOMA-ISI差异无统计学意义(均P>0.05),T2时3组患者血糖水平差异无统计学意义(均P>0.05)。P2组患者右侧卧位时CSA高于C组(P<0.05),Perlas分级1级发生率高于C组和P1组(均P<0.05);C组与P1组患者Perlas分级1级发生率差异无统计学意义(P>0.05);3组患者GV、GV/W、GV/W>1.5 ml/kg的发生率差异无统计学意义(均P>0.05);3组患者均未发生Perlas分级2级和反流误吸。与C组比较,T1时P2组患者口渴和饥饿VAS评分较低(均P<0.05);T2时P1组患者饥饿评分较低(P<Objective To evaluate the effect of different oral doses of carbohydrate solution(Shuneng)administered at postop‑erative 2-4 h on insulin resistance(IR)in patients undergoing laparoscopic cholecystectomy(LC).Methods A total of 150 patients,aged 18‒65 years,with American Society of Anesthesiologists(ASA)gradesⅠorⅡ,and body mass index(BMI)of 18‒30 kg/m^(2) who underwent LC surgery under general anesthesia were selected.According to the random number table method,they were divided into three groups(n=50):a fasting control group(group C),an oral 200 ml Shuneng group(group P1),and an oral 400 ml Shuneng group(group P2).All three groups of patients were fasted at 22:00,without drinking at 24:00 one night before operation.Patients in group P1 and group P2 were orally taken Shuneng at 200 ml and 400 ml 2-4 h before operation,respectively,while those in group C did not drink any liquid.Then,their general information were recorded.The concentrations of fasting glucose(FG)and fasting insulin(FINS)were measured 10 min before anesthesia induction(T1)and 10 min after extubation(T2).The homeostatic model assessment‑insulin re‑sistance(HOMA‑IR)and homeostatic model assessment‑insulin sensitivity index(HOMA‑ISI)were calculated by the homeostatic mod‑el assessment method.The gastric sinus cross‑sectional area(CSA)was measured at T_(1) by bedside gastric ultrasound with the patient in right lateral recumbent position.The gastric volume(GV),gastric volume‑to‑weight ratio(GV/W),the incidence of GV/W>1.5 ml/kg and Perlas classification were assessed to observe the incidence of regurgitation and aspiration.Their Visual Analog Scale(VAS)scores for hunger,thirst and anxiety were recorded at T_(1) and T_(2).The changes in mean arterial pressure(MAP)and heart rate of patients at ad‑mission(t_(1)),anesthesia induction(t_(2)),skin incision(t_(3)),pneumoperitoneum(t4)and withdrawal of the tube(t_(5))were recorded.Results There was no statistical difference in general information among the three groups(all P>0.05)

关 键 词：碳水化合物 胰岛素抵抗 腹腔镜胆囊切除术 胃排空 

分 类 号：R614[医药卫生—麻醉学]