Preoperative oral carbohydrates and postoperative insulin resistance
Preoperative oral carbohydrates and postoperative insulin resistance
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DOI：
10.1016/s0261-5614(99)80063-6
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发表时间：
1999-04-01
影响因子：
6.3
通讯作者：
Ljungqvist, O
中科院分区：
文献类型：
--
作者：
Nygren, J;Soop, M;Ljungqvist, O
手术前输注碳水化合物已被证明可以减少术后胰岛素抵抗。目前，我们调查的影响，碳水化合物饮料，给予手术前不久，对术后insulinsensitivity.Methods：胰岛素敏感性和葡萄糖周转（[6，6，H-2（2）]-D-葡萄糖）进行了测量，采用高胰岛素，血糖正常钳术前和术后择期手术。16例接受全髋关节置换术的患者被随机分配到术前口服碳水化合物（CHO-H，n = 8）或术前等量的安慰剂饮料（安慰剂，n = 8）。在手术前和手术后立即测量胰岛素敏感性。在术前和术后24 h研究接受择期结直肠手术的患者（CHO-C组（n = 7）和空腹组（n = 7））。禁食组在禁食过夜后进行手术。在两项研究中，CHO组在手术前一天晚上接受800 ml等渗的富含碳水化合物的饮料（100克碳水化合物），以及另外400英里（50 g碳水化合物）在麻醉开始前2小时。手术后，安慰剂组的胰岛素敏感性降低了37（P < 0.05 vs，术前），而CHO-H组无显著变化（-16%，p = NS）。在术后24 h钳夹期间，两组的胰岛素敏感性和全身葡萄糖处置均降低，但与CHO-C组相比，降低幅度更大（-49 +/- 6% vs. -26 +/-8%，P < 0.05空腹vs. CHO-C）。与整夜禁食后接受手术的患者相比，在择期手术前不久给予碳水化合物饮料的患者术后胰岛素敏感性降低较少。
Infusions of carbohydrates before surgery have been shown to reduce postoperative insulin resistance. Presently, we investigated the effects of a carbohydrate drink, given shortly before surgery, on postoperative insulin sensitivity.Methods: Insulin sensitivity and glucose turnover ([6, 6, H-2(2)]-D-glucose) were measured using hyperinsulinemic, normoglycemic clamps before and after elective surgery. Sixteen patients undergoing total hip replacement were randomly assigned to preoperative oral carbohydrate administration (CHO-H, n = 8) or the same amount of a placebo drink (placebo, n = 8) before surgery. Insulin sensitivity was measured before and immediately after surgery. Patients undergoing elective colorectal surgery were studied before surgery and 24 h postoperatively (CHO-C (n = 7), and fasted (n = 7), groups). The fasted group underwent surgery after an overnight fast. In both studies, the CHO groups received 800 mi of an isoosmolar carbohydrate rich beverage the evening before the operation (100g carbohydrates), as well as another 400 mi (50g carbohydrates) 2 h before the initiation of anesthesia.Results: Immediately after surgery, insulin sensitivity was reduced 37% in the placebo group (P < 0.05 vs, preoperatively) while no significant change was found in the CHO-H group (-16%, p = NS). During clamps performed 24 h postoperatively, insulin sensitivity and whole-body glucose disposal was reduced in both groups, but the reduction was greater compared to that in the CHO-C group (-49 +/- 6% vs. -26 +/- 8%, P < 0.05 fasted vs. CHO-C).Conclusions: Patients given a carbohydrate drink shortly before elective surgery displayed less reduced insulin sensitivity after surgery as compared to patients undergoing surgery after an overnight fast.