School of Medicine and Surgery, Milano - Bicocca University.
Department of Surgery, San Gerardo Hospital, Monza, Italy.
Curr Opin Clin Nutr Metab Care. 2020 Jul;23(4):262-270. doi: 10.1097/MCO.0000000000000661.
The aim of this review is to give an overview of recently published articles covering preoperative carbohydrate loading in surgical patients.
Between January 1, 2017, and December 31, 2019, 26 publications addressing the effect of carbohydrate load were retrieved through a systematic search. Seventeen were randomized clinical trials, three prospective observational studies and six retrospective series with case-control comparison. Most of the studies were underpowered, addressed surrogate endpoints, and variability among dose and timing of carbohydrate (CHO) treatment was high. The most recent literature endorses preoperative carbohydrate loading up to 2 h before operations as a safe treatment. The new evidence confirm that this strategy is effective in reducing perioperative insulin resistance and the proportion of hyperglycemia episodes, and improving patient well-being and comfort but without affecting surgery-related morbidity.
Further properly designed randomized clinical trials, addressing more clinically relevant endpoints such as length of hospitalization and morbidity rate, are warrant.
本综述旨在概述最近发表的涵盖手术患者术前碳水化合物负荷的文章。
2017 年 1 月 1 日至 2019 年 12 月 31 日期间，通过系统检索共检索到 26 篇关于碳水化合物负荷影响的出版物。其中 17 项为随机临床试验，3 项为前瞻性观察性研究，6 项为回顾性系列研究，其中包括病例对照比较。大多数研究的样本量不足，以替代终点为研究目标，碳水化合物（CHO）治疗的剂量和时间差异较大。最近的文献支持在手术前 2 小时内给予术前碳水化合物负荷，这是一种安全的治疗方法。新证据证实，这种策略可有效降低围手术期胰岛素抵抗和高血糖发作的比例，并改善患者的舒适度和舒适度，但不会影响与手术相关的发病率。
需要进一步设计适当的随机临床试验，以解决更具临床相关性的终点，如住院时间和发病率。
