Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery
Effects of preoperative oral carbohydrates and peptides on postoperative endocrine response, mobilization, nutrition and muscle function in abdominal surgery
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DOI：
10.1034/j.1399-6576.2003.00047.x
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发表时间：
2003-02-01
影响因子：
2.1
通讯作者：
Rodt, SÅ
中科院分区：
文献类型：
--
作者：
Henriksen, MG;Hessov, I;Rodt, SÅ
背景：手术成功的原因是长期处于相对外周胰岛素抵抗状态，手术前立即给予葡萄糖输注或口服富含碳水化合物的饮料，而不是禁食，可以减轻这种状态。本研究的目的是探讨碳水化合物或碳水化合物口服替代禁食是否能改善术后自主肌力、营养摄入量和步行能力，减少术后疲劳、焦虑和不适，减少手术后的内分泌反应。方法：48例患者随机分为3组，分别饮用2×400毫升高碳水化合物饮料或禁食过夜，只喝水。分别于术前、术后进行自主握力、股四头肌力量、体成分、肺功能、VAS评分、肌肉活检及胰岛素、胰升糖素、胰岛素样生长因子-1和游离脂肪酸的测定。结果：干预组术后肌肉组织糖原合成酶活性明显下降，联合干预组在术后1周和1个月后股四头肌力量下降较少(-10%比-16%，NS)和一个月(-5%比-13%，P<；0.05)。手术后内分泌反应的轻微变化在两组之间没有差异，在步行时间、营养摄入量或主观幸福感指标方面也没有差异。
Background: Surgery is succeeded by long-lasting state of relative peripheral insulin resistance, which is reduced by giving glucose infusion or oral carbohydrate-rich drinks immediate before operating instead of fasting. The aim of the present study was to investigate whether oral carbohydrate or carbohydrate with peptide drinks preoperatively instead of fasting would improve postoperative voluntary muscle strength, nutritional intake and ambulation, decrease postoperative fatigue, anxiety and discomfort, and reduce the endocrine response to surgery.Methods: Forty-eight patients were included and randomized into three groups to receive 2 x 400 ml of carbohydrate-rich drinks or to fast overnight and allowed only water. Voluntary grip and quadriceps strength, body composition, pulmonary function, VAS-score of eight parameters of wellbeing, muscle biopsies and insulin, glucagon, IGF-1 and free fatty acids were measured before and after the operation. The basic postoperative regimen for all groups were immediate oral nutrition and early enforced mobilization.Results:Significant postoperative decrease in glycogen synthase activity in the muscle biopsies was reduced in the intervention groups, and in combination, the intervention groups had a less reduced quadriceps strength after one week (-10% vs. -16%, NS) and one month (-5% vs. -13%, P < 0.05). Minor changes in the endocrine response to surgery were found without differences between the groups, and there were no differences between the groups in ambulation time, nutritional intake or subjective measures of wellbeing.