Thorell A, Nygren J, Ljungqvist O
Department of Surgery, Huddinge University Hospital, Sweden.
Curr Opin Clin Nutr Metab Care. 1999 Jan;2(1):69-78. doi: 10.1097/00075197-199901000-00012.
Elective surgery causes a marked, transient reduction in insulin sensitivity. The degree of the reduction is related to the magnitude of the operation. The type and duration of surgery performed, perioperative blood loss, and also the degree of postoperative insulin resistance have significant influences on the length of hospital stay. A novel approach to minimize insulin resistance after surgery is being presented and suggests that simply pretreating the elective surgical patient with sufficient amounts of carbohydrates instead of fasting can significantly reduce postoperative insulin resistance. It is not clear which mediators are the most important for the development of insulin resistance after surgery. Nevertheless, marked insulin resistance can develop after elective surgery without concomitant elevations in cortisol, catecholamines or glucagon. The main sites for insulin resistance seem to be extrahepatic tissues, probably skeletal muscle, where preliminary data suggest that the glucose transporting system is involved.
择期手术会导致胰岛素敏感性显著且短暂降低。降低程度与手术规模相关。所施行手术的类型和时长、围手术期失血情况以及术后胰岛素抵抗程度，均对住院时长有显著影响。一种旨在将术后胰岛素抵抗降至最低的新方法正在被提出，该方法表明，只需让择期手术患者预先摄入足量碳水化合物而非禁食，就能显著降低术后胰岛素抵抗。目前尚不清楚哪些介质对术后胰岛素抵抗的发生最为重要。然而，择期手术后可出现显著的胰岛素抵抗，而皮质醇、儿茶酚胺或胰高血糖素却并未随之升高。胰岛素抵抗的主要部位似乎是肝外组织，很可能是骨骼肌，初步数据表明葡萄糖转运系统与此有关。
