Rapp-Kesek Doris, Stridsberg Mats, Andersson Lars-Göran, Berne Christian, Karlsson Torbjörn
Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care, University Hospital, Uppsala, Sweden.
Scand Cardiovasc J. 2007 Apr;41(2):102-8. doi: 10.1080/14017430601050355.
Preoperative carbohydrate administration attenuates insulin resistance. We studied effects of preoperative oral carbohydrate loading in elderly patients undergoing coronary artery bypass grafting.
Eighteen patients were assigned either to get a carbohydrate drink or to be controls. Perioperatively, glucose was administered. A gastric emptying test was performed. Glucose and insulin concentrations were measured. Levels of glucose, insulin and stress hormones were studied pre-, per- and postoperatively.
Preoperative carbohydrate loading did not affect stress hormones. Gastric residual after the carbohydrate drink was 11+/-3% (mean+/-SEM). Glucose concentration was lower before anaesthesia induction in the carbohydrate group, possibly due to increased insulin release. Insulin levels differed at baseline, induction and day six. All patients returned to baseline on day six.
The study group was insulin resistant on postoperative day one and two. The effects were explainable by the traumatic stress response. No adverse effect was noted from the carbohydrate drink. If glucose is administered intravenously during surgery, there is no obvious advantage of preoperative carbohydrate loading on insulin resistance or stress hormone response.
术前给予碳水化合物可减轻胰岛素抵抗。我们研究了术前口服碳水化合物负荷对接受冠状动脉搭桥术的老年患者的影响。
18例患者被分为两组，一组给予碳水化合物饮料，另一组作为对照组。围手术期给予葡萄糖。进行了胃排空试验。测量了葡萄糖和胰岛素浓度。研究了术前、术中及术后的葡萄糖、胰岛素和应激激素水平。
术前碳水化合物负荷对应激激素无影响。饮用碳水化合物饮料后胃残余量为11±3%（平均值±标准误）。碳水化合物组麻醉诱导前葡萄糖浓度较低，可能是由于胰岛素释放增加。胰岛素水平在基线、诱导期和术后第六天有所不同。所有患者在第六天恢复到基线水平。
研究组在术后第一天和第二天存在胰岛素抵抗。这些影响可由创伤应激反应解释。未观察到碳水化合物饮料有不良反应。如果在手术期间静脉给予葡萄糖，术前碳水化合物负荷对胰岛素抵抗或应激激素反应没有明显优势。
