术前口服单剂量和双剂量碳水化合物对胃切除术患者胰岛素抵抗的影响：一项前瞻性随机对照试验。

Effects of preoperative oral single-dose and double-dose carbohydrates on insulin resistance in patients undergoing gastrectomy:a prospective randomized controlled trial.

机构信息

West China School of Nursing /West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.

出版信息

Clin Nutr. 2021 Apr;40(4):1596-1603. doi: 10.1016/j.clnu.2021.03.002. Epub 2021 Mar 7.

DOI:10.1016/j.clnu.2021.03.002

Abstract

BACKGROUND & AIMS: Preoperative oral carbohydrates are strongly recommended for routine use before various elective procedures. The regimen mainly includes preoperative oral single-dose carbohydrate (2-3 h before surgery) and preoperative oral double-dose carbohydrates (10 h before surgery and 2-3 h before surgery). The choice between the two options is still controversial.

METHODS

A total of 139 patients with gastric cancer who underwent radical gastrectomy were recruited from a hospital in Sichuan Province, China. The patients were randomly assigned to a single-dose group (n = 70) or a double-dose group (n = 69). Insulin resistance indicators, subjective comfort indicators, inflammatory mediators, immunological indicators, postoperative recovery indexes, and complications were compared between the two groups.

RESULTS

There were no differences in insulin resistance indicators (fasting plasma glucose, fasting insulin, and homeostasis model assessment indexes), inflammatory mediators (C-reactive protein, interleukin-6, and tumor necrosis factor-α), immunological indicators (CD3+, CD4+, CD8+, and CD4+/CD8+) between the single-dose group and double-dose group (all P > 0.05) at preoperative day 1, preoperative 3 h, and postoperative day 1. There were no differences in subjective comfort indicators (thirst, hunger, anxiety, nausea, fatigue, and weakness) between the two groups (all P > 0.05) at preoperative day 1, preoperative 3 h, preoperative 1 h, and postoperative day 1. The postoperative recovery indexes and complications (exhaust time, liquid intake time, postoperative hospital stay, complication incidence, unplanned readmission rate, and unplanned reoperation rate 30 days after operation) did not significantly differ between the two groups (all P > 0.05). The number of preoperative nighttime urinations in the double-dose group was higher than that in the single-dose group (88.3% VS 48.5%, P < 0.001), and the number of hours of preoperative sleep in the double-dose group was lower than that in the single-dose group (4.56 ± 0.68 VS 5.71 ± 0.57, P < 0.001).

CONCLUSION

Oral carbohydrates administered the night before surgery did not enhance the effects of oral carbohydrates administered 2-3 h before surgery on insulin resistance, subjective comfort, inflammation, and immunity and might affect the patients' night rest. In making a decision between oral carbohydrate regimes, evening carbohydrates could be omitted.

TRIAL REGISTRATION

ChiCTR, ChiCTR1900020608. Registered January 10, 2019, http://www.chictr.org.cn: ChiCTR1900020608.

摘要

背景与目的

术前口服碳水化合物在各种择期手术前强烈推荐常规使用。该方案主要包括术前口服单剂量碳水化合物（术前 2-3 小时）和术前口服双剂量碳水化合物（术前 10 小时和术前 2-3 小时）。两种选择之间的选择仍存在争议。

方法

共纳入中国四川省一家医院 139 例接受胃癌根治术的患者。患者被随机分配到单剂量组（n=70）或双剂量组（n=69）。比较两组患者的胰岛素抵抗指标、主观舒适度指标、炎症介质、免疫指标、术后恢复指标和并发症。

结果

两组患者在术前第 1 天、术前 3 小时和术后第 1 天的胰岛素抵抗指标（空腹血糖、空腹胰岛素和稳态模型评估指数）、炎症介质（C 反应蛋白、白细胞介素-6 和肿瘤坏死因子-α）、免疫指标（CD3+、CD4+、CD8+和 CD4+/CD8+）均无差异（均 P>0.05）。两组患者在术前第 1 天、术前 3 小时、术前 1 小时和术后第 1 天的主观舒适度指标（口渴、饥饿、焦虑、恶心、疲劳和虚弱）均无差异（均 P>0.05）。两组患者的术后恢复指标和并发症（排气时间、液体摄入时间、术后住院时间、并发症发生率、计划外再入院率和术后 30 天计划外再次手术率）无显著差异（均 P>0.05）。双剂量组术前夜间排尿次数多于单剂量组（88.3% vs. 48.5%，P<0.001），双剂量组术前睡眠时间少于单剂量组（4.56±0.68 vs. 5.71±0.57，P<0.001）。