Karolinska Institutet, CLINTEC, Division of Surgery, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden.
Best Pract Res Clin Anaesthesiol. 2009 Dec;23(4):401-9. doi: 10.1016/j.bpa.2009.08.004.
The concept of preoperative overnight fasting was challenged and proved to have no benefits over allowing patients to drink clear fluids up until 2 h before surgery. This led to changes in the guidelines for preoperative fasting in many countries around the world. This concept has more recently been developed further. Mounting evidence indicates that instead of being operated in the traditional overnight fasted state, undergoing surgery in the carbohydrate-fed state has many clinical benefits. Many of these clinical effects can be related to reduced postoperative insulin resistance by preoperative carbohydrate loading. This article summarises the present understanding of the mechanisms behind the positive clinical effects and gives an overview of the information available regarding the clinical effects of this treatment. Finally, the article summarises the most recently published national guidelines on preoperative fasting routines where preoperative carbohydrates are recommended for use before a major surgery. These are to be considered for all patients allowed to drink clear fluids and undergoing elective surgery.
术前隔夜禁食的概念受到了挑战，并被证明在让患者在手术前 2 小时内饮用清澈液体方面没有任何益处。这导致了世界上许多国家术前禁食指南的改变。这一概念最近又有了进一步的发展。越来越多的证据表明，与传统的隔夜禁食状态相比，在接受手术时处于碳水化合物喂养状态具有许多临床益处。许多这些临床效果可以通过术前碳水化合物负荷来减少术后胰岛素抵抗。本文总结了目前对这种积极的临床效果背后的机制的理解，并概述了关于这种治疗方法的临床效果的可用信息。最后，本文总结了最近发布的关于术前碳水化合物推荐用于重大手术前的术前禁食常规的国家指南。这些都应考虑用于允许饮用清澈液体并接受择期手术的所有患者。
