Pre-operative nutrition and carbohydrate loading
Pre-operative nutrition and carbohydrate loading
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DOI：
10.1017/s0029665111000450
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发表时间：
2011-08-01
影响因子：
7
通讯作者：
Kratzing, Caroline
中科院分区：
文献类型：
--
作者：
Kratzing, Caroline
最佳的营养状态是提供成功手术结果的重要考虑因素。不幸的是，手术的许多方面对提供这一点并不具有建设性。此外，对损伤的代谢和免疫反应导致分解代谢状态和胰岛素抵抗，这是已知的术后并发症的危险因素。术后积极的胰岛素治疗已被证明可以降低发病率和死亡率，但如果通过术前碳水化合物负荷减轻胰岛素抵抗，也可以达到类似的结果。已经发现，在手术前2小时内饮用含碳水化合物的饮料是一种有效的方法，可以减轻胰岛素抵抗，最大限度地减少蛋白质损失，减少住院时间，改善患者舒适度，而不会对胃排空造成不利影响。强化恢复方案已将碳水化合物负荷作为旨在减轻术后压力和改善恢复过程的几项战略之一。对这些方案的益处的研究表明，术后住院时间显著缩短，恢复正常功能的速度更快，手术并发症的发生率更低。作为有利证据的结果，它们现在正在许多外科单位实施。使用免疫增强型饮食，即补充n-3脂肪酸、精氨酸、谷氨酰胺和/或核苷酸，可进一步促进术后恢复。这些都有可能增强免疫系统，改善伤口愈合，减少炎症标志物。探索免疫营养的益处和巩固碳水化合物负荷的使用的研究正在进行中；然而，有强有力的证据表明，良好的术前营养和改善手术结果之间存在联系。
An optimal nutritional state is an important consideration in providing successful operative outcomes. Unfortunately, many aspects of surgery are not constructive to providing this. In addition, the metabolic and immune response to injury induces a catabolic state and insulin resistance, a known risk factor of post-operative complications. Aggressive insulin therapy post-operatively has been shown to reduce morbidity and mortality but similar results can be achieved when insulin resistance is lessened by the use of pre-operative carbohydrate loading. Consuming carbohydrate-containing drinks up to 2 h before surgery has been found to be an effective way to attenuate insulin resistance, minimise protein losses, reduce hospital stays and improve patient comfort without adversely affecting gastric emptying. Enhanced recovery programmes have employed carbohydrate loading as one of several strategies aimed at reducing post-operative stress and improving the recovery process. Studies examining the benefits of these programmes have demonstrated significantly shorter post-operative hospital stays, faster return to normal functions and lower occurrences of surgical complications. As a consequence of the favourable evidence they are now being implemented in many surgical units. Further benefit to post-operative recovery May be found with the use of immune-enhancing diets, i.e. supplementation with n-3 fatty acids, arginine, glutamine and/or nucleotides. These have the potential to boost the immune system, improve wound healing and reduce inflammatory markers. Research exploring the benefits of immunonutrition and solidifying the use of carbohydrate loading is ongoing; however, there is strong evidence to link good pre-operative nutrition and improved surgical outcomes.