Department of Critical Care Medicine and Dentistry, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan.
Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Kanagawa, Japan.
PLoS One. 2019 May 13;14(5):e0216525. doi: 10.1371/journal.pone.0216525. eCollection 2019.
We investigated the effects of preoperative oral carbohydrate loading on intraoperative catabolism, nutritional parameters, and adipocytokine levels during anesthesia.
Study participants were randomized to two groups who were allowed to consume either no more than 250 mL of 18% oral carbohydrate solution (Arginaid Water: AW group) or no more than 500 mL of plain water (PW group) within the 2 hours before surgery, with no intraoperative glucose administration. Percentage changes from preoperative values of resting metabolic rate (RMR) and total body water (TBW), determined by bioelectrical impedance analysis (BIA), were compared. Blood levels of serum ketone bodies, free fatty acids (FFAs), insulin, 3-methyl histidine, blood glucose, retinol binding protein, adiponectin, and leptin were measured. BIA measurement and blood sampling were performed on entry to the operating room (M1) and 2 hours after the induction of anesthesia (M2). Chi squared test, Mann-Whitney U test, and Wilcoxon's test were used for comparisons of parameters. P values less than 0.05 constituted a significant difference.
Seventeen patients per group (34 patients total) were enrolled. RMR and TBW values did not differ between M1 and M2 measurements. Participants in the AW group had lower blood ketone body and FFA levels and higher insulin levels at M1. However, their ketone body and FFA levels rose and insulin levels fell after 2 hours, although ketone body and FFA levels in the AW group were still lower than those in the PW group. Although retinol binding protein, adiponectin, and leptin levels were not different in terms of preoperative oral carbohydrate loading, the levels of these substances in both groups were lower after 2 hours compared with levels on operating room entry.
Preoperative oral carbohydrate loading without intraoperative glucose administration appears to suppress catabolism for 2 hours after the start of surgery.
我们研究了术前口服碳水化合物负荷对麻醉期间术中分解代谢、营养参数和脂肪细胞因子水平的影响。
研究参与者被随机分为两组，允许在手术前 2 小时内分别饮用不超过 250 毫升 18%口服碳水化合物溶液（Arginaid Water：AW 组）或不超过 500 毫升白开水（PW 组），术中不给予葡萄糖。通过生物电阻抗分析（BIA）比较术前静息代谢率（RMR）和总体水（TBW）的百分比变化。测量血清酮体、游离脂肪酸（FFAs）、胰岛素、3-甲基组氨酸、血糖、视黄醇结合蛋白、脂联素和瘦素的血液水平。在进入手术室时（M1）和麻醉诱导后 2 小时（M2）进行 BIA 测量和血液采样。使用卡方检验、Mann-Whitney U 检验和 Wilcoxon 检验比较参数。P 值小于 0.05 表示差异具有统计学意义。
每组纳入 17 例患者（共 34 例患者）。M1 和 M2 测量的 RMR 和 TBW 值无差异。AW 组患者在 M1 时的血液酮体和 FFA 水平较低，胰岛素水平较高。然而，2 小时后，他们的酮体和 FFA 水平上升，胰岛素水平下降，但 AW 组的酮体和 FFA 水平仍低于 PW 组。尽管术前口服碳水化合物负荷对视黄醇结合蛋白、脂联素和瘦素水平没有影响，但与进入手术室时相比，两组的这些物质水平在 2 小时后均较低。
在手术开始后 2 小时内，给予不含术中葡萄糖的术前口服碳水化合物负荷似乎可以抑制分解代谢。
