Kweon Suc-Hyun, Park Jin Sung, Lee Yeong Chang
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, Iksan, Korea.
Republic of Korea Army, Damyang, Korea.
Geriatr Orthop Surg Rehabil. 2020 Oct 9;11:2151459320958609. doi: 10.1177/2151459320958609. eCollection 2020.
The purpose of this study was to investigate the clinical effects of oral carbohydrate intake for cephalomedullary nailing on proximal femoral fractures and patient satisfaction.
88 patients were admitted to our hospital with proximal femoral fracture from July 2019 to December 2019. All patients were treated with closed reduction and internal fixation (CR&IF, Cephalomedullary nailing) under spinal anesthesia. The exclusion criteria included the presence of endocrine disorders including diabetes mellitus (DM), patients treated with steroids, and cognitive impairment. Additionally, those with fasting blood glucose levels above 126 mg / dl or HbA1C> 6.5% were considered as having undiagnosed DM. After obtaining informed consent, the subjects were randomized into either the preoperative oral carbohydrate (POC) group or control group. Patients who were assembled into the control group fasted including water from midnight of the day of the surgical procedure according to the conventional method. Patients assembled into the POC group received 400 ml of oral carbohydrate solution (Nucare NONPO, DAESANG, 12.8%, 1 kcal/ml)) between 21-24 hours on the day before operation and 400 ml oral carbohydrate solution 2 hours before the administration of anesthesia. Serum glucose on the day before operation at 7 am (before breakfast, baseline), immediately before anesthesia, at skin incision, 1 hour, 4 hours, 6 hours, 24 hours after anesthesia, and 3 days after surgery (before breakfast) was measured, and insulin, cortisol, and IL-6 were measured at baseline 7 am at day before operation, immediately before anesthesia, 4 hours and 24 hours after anesthesia, and 3 days after surgery (before breakfast). The patients completed questionnaires about their satisfaction (thirst, hunger, nausea and vomiting, and anxiety) in the morning (before the surgery) on the day of the surgery. Additionally, the length of hospital stay (LOS) and preoperative opioid usage was also investigated.
The operative characteristics of the patients did not differ between the groups except for the actual fasting time. The glucose levels were higher in the control group at skin incision; however, there were no significant differences in both groups at other time points. Additionally, insulin, insulin resistance, cortisol, and IL-6 also did not differ significantly between the 2 groups at all time-points. Among the factors related to patient satisfaction, the POC group showed significantly higher scores for thirst and hunger factors and shorter LOS than the control group.
The intake of oral carbohydrates in patients treated with closed reduction and internal fixation for proximal femoral fractures does not affect the improvement of post-operative insulin resistance. However, there was significant improvement in patients' thirst and hunger before surgery and LOS.
本研究旨在探讨口服碳水化合物对头髓内钉治疗股骨近端骨折的临床效果及患者满意度。
2019年7月至2019年12月，88例股骨近端骨折患者入住我院。所有患者均在脊髓麻醉下进行闭合复位内固定（CR&IF，髓内钉）治疗。排除标准包括存在内分泌紊乱（如糖尿病）、接受类固醇治疗的患者以及认知障碍患者。此外，空腹血糖水平高于126mg/dl或糖化血红蛋白>6.5%的患者被视为患有未确诊的糖尿病。获得知情同意后，将受试者随机分为术前口服碳水化合物（POC）组或对照组。按照传统方法，对照组患者在手术当天午夜起禁食禁水。POC组患者在手术前一天21-24小时接受400ml口服碳水化合物溶液（Nucare NONPO，大昌华嘉，12.8%，1kcal/ml），并在麻醉前2小时接受400ml口服碳水化合物溶液。测量手术前一天上午7点（早餐前，基线）、麻醉前即刻、皮肤切开时、麻醉后1小时、4小时、6小时、24小时以及术后3天（早餐前）的血糖，同时测量手术前一天上午7点基线、麻醉前即刻、麻醉后4小时和24小时以及术后3天（早餐前）的胰岛素、皮质醇和白细胞介素-6。患者在手术当天上午（手术前）完成关于满意度（口渴、饥饿、恶心呕吐和焦虑）的问卷调查。此外，还调查了住院时间（LOS）和术前阿片类药物的使用情况。
除实际禁食时间外，两组患者的手术特征无差异。对照组在皮肤切开时血糖水平较高；然而，两组在其他时间点无显著差异。此外，两组在所有时间点的胰岛素、胰岛素抵抗、皮质醇和白细胞介素-6也无显著差异。在与患者满意度相关的因素中，POC组在口渴和饥饿因素方面的得分显著高于对照组，且住院时间更短。
股骨近端骨折闭合复位内固定治疗患者口服碳水化合物对术后胰岛素抵抗的改善无影响。然而，患者术前的口渴和饥饿感以及住院时间有显著改善。
