Gümüs Kenan, Pirhan Yavuz, Aydın Gökcen, Keloglan Seval, Tasova Volkan, Kahveci Mürsel
Department of Surgical Nursing, Faculty of Health Sciences, Amasya University, Amasya, Turkey.
Department of General Surgery, Sabuncuoğlu Şerefeddin Research and Training Hospital, Amasya University, Amasya, Turkey.
J Perianesth Nurs. 2021 Oct;36(5):526-531. doi: 10.1016/j.jopan.2020.10.012. Epub 2021 Apr 26.
The aim of this study is to investigate the effects of preoperative oral intake of liquid carbohydrate on postoperative stress parameters (blood glucose, insulin resistance, cortisol, noradrenaline, and adrenaline levels) in patients who underwent laparoscopic cholecystectomy.
This is an experimental study with intervention and control groups.
The sample consisted of 68 patients who underwent laparoscopic cholecystectomy (control group = 33; intervention group = 35). Twelve-hour preoperative fasting was applied to the patients in the control group in accordance with the clinical routine. Clear oral liquid carbohydrate (400 mL; 12.5 g/100 mL maltodextrin, 50 kcal/100 mL, pH 5.0) was administered to the patients in the intervention group at the preoperative second hour. Blood samples were taken from the patients at the preoperative 2nd and postoperative 2nd and 24th hours, and their blood glucose, insulin resistance, cortisol, noradrenaline, and adrenaline levels were measured.
Preoperative oral intake of carbohydrate had no effect on blood glucose (P > .05) but decreased insulin resistance at the postoperative 24th hour (P = .044; intervention and control group: 3.62 ± 3.44 to 8.16 ± 12.57 respectively) and cortisol level at the postoperative 2nd hour (P = .005; intervention and control group: 15.16 ± 6.53 mg/dl to 20.14 ± 7.49 mg/dl, respectively). In all of the three measurements, we found that the noradrenaline level of the patients in the intervention group was higher than the value of those in the control group (319.80 ± 301.49 pg/mL to 211.65 ± 141.11 pg/mL [P = .450]; 361.40 ± 213.50 pg/mL to 216.13 ± 114.53 [P = .001]; 268.40 ± 164.04 pg/mL to 196.00 ± 83.33 pg/mL [P = .026], respectively). Preoperative oral intake of liquid carbohydrate had no effect on postoperative adrenaline level (P > .05).
Oral intake of liquid carbohydrate given at the preoperative 2nd hour decreased postoperative stress response through insulin resistance and cortisol.
本研究旨在调查术前口服液体碳水化合物对接受腹腔镜胆囊切除术患者术后应激参数（血糖、胰岛素抵抗、皮质醇、去甲肾上腺素和肾上腺素水平）的影响。
这是一项有干预组和对照组的实验研究。
样本包括68例接受腹腔镜胆囊切除术的患者（对照组 = 33例；干预组 = 35例）。对照组患者按照临床常规进行术前12小时禁食。干预组患者在术前第2小时给予清亮口服液体碳水化合物（400 mL；12.5 g/100 mL麦芽糊精，50 kcal/100 mL，pH 5.0）。在术前第2小时、术后第2小时和第24小时采集患者血样，测量其血糖、胰岛素抵抗、皮质醇、去甲肾上腺素和肾上腺素水平。
术前口服碳水化合物对血糖无影响（P > 0.05），但术后第24小时胰岛素抵抗降低（P = 0.044；干预组和对照组分别为3.62±3.44至8.16±12.57），术后第2小时皮质醇水平降低（P = 0.005；干预组和对照组分别为15.16±6.53 mg/dl至20.14±7.49 mg/dl）。在所有三次测量中，我们发现干预组患者的去甲肾上腺素水平高于对照组患者（分别为319.80±301.49 pg/mL至211.65±141.11 pg/mL [P = 0.450]；361.40±213.50 pg/mL至216.13±114.53 [P = 0.001]；268.40±164.04 pg/mL至196.00±83.33 pg/mL [P = 0.026]）。术前口服液体碳水化合物对术后肾上腺素水平无影响（P > 0.05）。
术前第2小时口服液体碳水化合物通过降低胰岛素抵抗和皮质醇水平减轻术后应激反应。
