From the Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute (BL,SS, J-KS, HYK, HL, Y-LK); and Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J-KS, Y-LK).
Eur J Anaesthesiol. 2017 Nov;34(11):740-747. doi: 10.1097/EJA.0000000000000637.
In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation.
We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation.
A randomised controlled trial.
Primary care in a university hospital in Korea from January 2015 to July 2016.
Sixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study.
The CHO group received oral CHO (400 ml) the prior evening and 2 to 3 h before surgery, and the control group was fasted from food and water according to standard protocol.
Insulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48 h after surgery.
Insulin sensitivity was greater (P = 0.002) and plasma FFA concentrations were lower (P = 0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7) ng ml, P = 0.031].
A preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact of preoperative CHO on myocardial ischaemia and cardiac function after coronary revascularisation.
Clinicaltrials.gov identifier: NCT 02330263.
在空腹心脏手术患者中，术前碳水化合物（CHO）饮料摄入可减轻胰岛素抵抗并改善心脏代谢，尽管其在心脏手术后的有益效果并不明显，可能是由于体外循环相关的极端全身炎症所致。
我们旨在评估在非体外循环冠状动脉血运重建中，术前 CHO 摄入是否会影响胰岛素抵抗和游离脂肪酸（FFA）浓度。
一项随机对照试验。
韩国一所大学医院的基层医疗。
2015 年 1 月至 2016 年 7 月期间，60 例择期行多支非体外循环冠状动脉血运重建的患者被随机分为两组。有 3 例患者被排除在分析之外，57 例患者完成了研究。
CHO 组于前夜和手术前 2 至 3 小时口服 CHO（400ml），对照组按标准方案禁食水。
麻醉诱导后和手术后两次通过短胰岛素耐量试验评估胰岛素抵抗。术后连续 48 小时测定 FFA、C 反应蛋白和肌酸激酶-MB 浓度。
与对照组相比，CHO 组麻醉诱导后胰岛素敏感性更高（P=0.002），FFA 浓度更低（P=0.001），但手术后两组间无差异。CHO 组术后肌酸激酶-MB 浓度峰值明显低于对照组[8.8（5.4 至 18.2）vs. 6.4（3.5 至 9.7）ng/ml，P=0.031]。
与手术开始时禁食相比，术前 CHO 补充可显著降低胰岛素抵抗和 FFA 浓度，但在非体外循环冠状动脉血运重建后这些益处消失。尽管这些益处是短暂的，但它们导致心肌损伤减少，需要进一步研究术前 CHO 对冠状动脉血运重建后心肌缺血和心功能的影响。
Clinicaltrials.gov 标识符：NCT 02330263。
