Nygren J, Soop M, Thorell A, Sree Nair K, Ljungqvist O
Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Clin Nutr. 1999 Apr;18(2):117-20. doi: 10.1054/clnu.1998.0019.
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.
Insulin sensitivity and glucose turnover ([6, 6,(2)H(2)]-D-glucose) were measured using hyper-insulinemic, 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 ml of an isoosmolar carbohydrate rich beverage the evening before the operation (100g carbohydrates), as well as another 400 ml (50g carbohydrates) 2 h before the initiation of anesthesia.
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 24h 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).
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.
术前输注碳水化合物已被证明可降低术后胰岛素抵抗。目前，我们研究了术前不久饮用碳水化合物饮料对术后胰岛素敏感性的影响。
在择期手术前后，使用高胰岛素正常血糖钳夹技术测量胰岛素敏感性和葡萄糖周转率（[6, 6, (2)H(2)] - D - 葡萄糖）。16例行全髋关节置换术的患者被随机分为术前口服碳水化合物组（CHO - H，n = 8）或术前饮用等量安慰剂饮料组（安慰剂组，n = 8）。在手术前和手术后立即测量胰岛素敏感性。对择期行结直肠手术的患者在手术前和术后24小时进行研究（CHO - C组（n = 7）和禁食组（n = 7））。禁食组在禁食过夜后进行手术。在两项研究中，CHO组在手术前一晚饮用800毫升等渗富含碳水化合物饮料（100克碳水化合物），并在麻醉开始前2小时再饮用400毫升（50克碳水化合物）。
手术后立即，安慰剂组胰岛素敏感性降低37%（与术前相比P < 0.05），而CHO - H组未发现显著变化（降低16%，p = 无统计学意义）。在术后24小时进行钳夹时，两组的胰岛素敏感性和全身葡萄糖处理均降低，但与CHO - C组相比降低幅度更大（禁食组为 - 49 ± 6%，CHO - C组为 - 26 ± 8%，禁食组与CHO - C组相比P >> 0.05）。
与禁食过夜后进行手术的患者相比，择期手术前不久饮用碳水化合物饮料的患者术后胰岛素敏感性降低程度较小。
