Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
Department of Orthopedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
World J Surg. 2022 Apr;46(4):791-799. doi: 10.1007/s00268-021-06437-1. Epub 2022 Jan 10.
Preoperative carbohydrate treatment attenuates insulin resistance and improves metabolism to an anabolic state. Despite these benefits, impaired glycemic control and aspiration risk related to gastroparesis represent concerns for patients with diabetes undergoing surgery. This randomized controlled trial investigated the effects of oral carbohydrate therapy on perioperative glucose variability, metabolic responses, and gastric volume in diabetic patients undergoing elective total hip or knee arthroplasty.
Fifty diabetic patients scheduled to undergo elective total knee or hip arthroplasty during August 2019-October 2020 were randomly assigned to a control or carbohydrate therapy (CHO) group. CHO group of patients received a 400-mL carbohydrate drink 2-3 h before anesthesia; control group of patients underwent overnight fasting from midnight, one night before surgery. Blood glucose levels were measured before intake of the carbohydrate drink, before spinal anesthesia, preoperatively, immediately postoperatively, and 1 h postoperatively. Insulin level and gastric volume were measured before spinal anesthesia.
The glucose variability of patients in the CHO group was significantly higher than that of those in the control group (16.5 vs. 10.1%, P = 0.008). Similarly, insulin resistance was higher in the CHO group than in the control group (8.5 vs. 2.7, P < 0.001). The gastric volume did not differ significantly between the groups (61.3 vs. 15.2 ml, P = 0.082).
Preoperative oral carbohydrate therapy increases glucose variability and insulin resistance in diabetic patients. Therefore, carbohydrate beverages should be cautiously administered to diabetic patients, considering metabolic and safety aspects. Trial registration number ClinicalTrials.gov (No. NCT04013594).
术前碳水化合物治疗可减轻胰岛素抵抗并使代谢向合成状态转变。尽管有这些益处，但糖尿病患者手术时存在血糖控制受损和胃瘫相关的误吸风险。本随机对照试验研究了口服碳水化合物治疗对择期全髋关节或膝关节置换术糖尿病患者围手术期血糖变异性、代谢反应和胃容量的影响。
2019 年 8 月至 2020 年 10 月期间，50 例拟行择期全膝关节或髋关节置换术的糖尿病患者被随机分配至对照组或碳水化合物治疗（CHO）组。CHO 组患者于麻醉前 2-3 小时给予 400ml 碳水化合物饮料；对照组患者于手术前一晚午夜开始禁食。分别在摄入碳水化合物饮料前、脊髓麻醉前、术前、术后即刻和术后 1 小时测量血糖水平，在脊髓麻醉前测量胰岛素水平和胃容量。
CHO 组患者的血糖变异性明显高于对照组（16.5%比 10.1%，P=0.008）。同样，CHO 组患者的胰岛素抵抗也高于对照组（8.5 比 2.7，P<0.001）。两组间胃容量无显著差异（61.3 比 15.2ml，P=0.082）。
术前口服碳水化合物治疗会增加糖尿病患者的血糖变异性和胰岛素抵抗。因此，在考虑代谢和安全性方面，应谨慎给予糖尿病患者碳水化合物饮料。临床试验注册号：ClinicalTrials.gov（编号：NCT04013594）。
