Feguri Gibran Roder, Lima Paulo Ruiz Lúcio, Lopes Andréa Mazoni, Roledo Andréa, Marchese Miriam, Trevisan Mônica, Ahmad Haitham, Freitas Bruno Baranhuk de, Aguilar-Nascimento José Eduardo de
Rev Bras Cir Cardiovasc. 2012 Jan-Mar;27(1):7-17. doi: 10.5935/1678-9741.20120004.
Limited information is available about preoperative fasting abbreviation with administration of liquid enriched with carbohydrates (CHO) in cardiovascular surgeries.
To evaluate clinical variables, security of the method and effects on the metabolism of patients undergoing fasting abbreviation in coronary artery bypass graft (CABG) surgery.
Forty patients undergoing CABG were randomized to receive 400 ml (6 hours before) and 200 ml (2 hours before) of maltodextrin at 12.5% (Group I, n=20) or just water (Group II, n=20) before anesthetic induction. Perioperative clinical variables were evaluated. Insulin resistance (IR) was evaluated by Homa-IR index and also by the need of exogenous insulin; pancreatic beta-cell excretory function by Homa-Beta index and glycemic control by tests of capillary glucose.
Deaths, bronchoaspiration, mediastinitis, stroke and acute myocardial infarction did not occur. Atrial fibrillation occurred in two patients of each group and infectious complications did not differ among groups (P=0.611). Patients of Group I presented two days less of hospital stay (P=0.025) and one day less in the ICU (P<0.001). The length of time using dobutamine was shorter in Group I (P=0.034). Glycemic control in the first 6h after surgery was worse for Group II (P=0.012). IR was verified and did not differ among groups (P>0.05). A decline in the endogenous production of insulin was observed in both groups (P<0.001).
Preoperative fasting abbreviation with the administration of CHO in the CABG was safe. The glycemic control improved in the ICU; there was less time in the use of dobutamine and length of hospital and ICU stay was reduced. However, neither IR nor morbimortality during hospital phase were influenced.
关于心血管手术中采用富含碳水化合物（CHO）的液体进行术前禁食缩短的信息有限。
评估冠状动脉搭桥术（CABG）中进行禁食缩短的患者的临床变量、该方法的安全性及其对代谢的影响。
40例行CABG的患者被随机分为两组，麻醉诱导前，第一组（n = 20）在术前6小时接受400毫升12.5%的麦芽糊精、术前2小时接受200毫升12.5%的麦芽糊精，第二组（n = 20）仅接受水。评估围手术期临床变量。通过稳态模型评估胰岛素抵抗（IR）指数（Homa-IR）以及外源性胰岛素需求来评估胰岛素抵抗；通过稳态模型评估β细胞功能指数（Homa-Beta）评估胰腺β细胞排泄功能，通过毛细血管血糖检测评估血糖控制情况。
未发生死亡、支气管误吸、纵隔炎、中风和急性心肌梗死。每组各有两名患者发生房颤，且各组间感染并发症无差异（P = 0.611）。第一组患者的住院时间缩短两天（P = 0.025），重症监护病房（ICU）停留时间缩短一天（P < 0.001）。第一组使用多巴酚丁胺的时间较短（P = 0.034）。术后前6小时第二组的血糖控制较差（P = 0.012）。两组均证实存在胰岛素抵抗，且组间无差异（P > 0.05）。两组内源性胰岛素分泌均下降（P < 0.001）。
CABG术前采用CHO进行禁食缩短是安全的。ICU中的血糖控制得到改善；多巴酚丁胺使用时间减少，住院和ICU停留时间缩短。然而，住院期间的胰岛素抵抗和病死率均未受影响。
