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结直肠术前碳水化合物负荷:随机对照试验的系统评价和荟萃分析。

Preoperative carbohydrate loading before colorectal surgery: a systematic review and meta-analysis of randomized controlled trials.

机构信息

Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.

出版信息

Int J Colorectal Dis. 2022 Dec;37(12):2431-2450. doi: 10.1007/s00384-022-04288-3. Epub 2022 Dec 6.


DOI:10.1007/s00384-022-04288-3
PMID:36472671
Abstract

PURPOSE: Preoperative carbohydrate loading has been introduced as a component of many enhanced recovery after surgery programs. Evaluation of current evidence for preoperative carbohydrate loading in colorectal surgery has never been synthesized. METHODS: MEDLINE, Embase, and CENTRAL were searched until May 2021. Randomized controlled trials (RCTs) comparing patients undergoing colorectal surgery with and without preoperative carbohydrate loading were included. Primary outcomes were changes in blood insulin and glucose levels. A pairwise meta-analysis was performed using inverse variance random effects. RESULTS: The search yielded 3656 citations, from which 12 RCTs were included. In total, 387 patients given preoperative carbohydrate loading (47.2% female, age: 62.0 years) and 371 patients in control groups (49.4% female, age: 61.1 years) were included. There was no statistical difference for blood glucose and insulin levels between both patient groups. Patients receiving preoperative carbohydrate loading experienced a shorter time to first flatus (SMD: - 0.48 days, 95% CI: - 0.84 to - 0.12, p = 0.008) and stool (SMD: - 0.50 days, 95% CI: - 0.86 to - 0.14, p = 0.007). Additionally, length of stay was shorter in the preoperative carbohydrate loading group (SMD: - 0.51 days, 95% CI: - 0.88 to - 0.14, p = 0.007). There was no difference in postoperative morbidity and patient well-being between both groups. CONCLUSIONS: Preoperative carbohydrate loading does not significantly impact postoperative glycemic control in patients undergoing colorectal surgery; however, it may be associated with a shorter length of stay and faster return of bowel function. It merits consideration for inclusion within colorectal enhanced recovery after surgery protocols.

摘要

目的:术前碳水化合物负荷已被引入许多术后恢复增强方案中。尚未对结直肠手术中术前碳水化合物负荷的现有证据进行综合评价。

方法:检索 MEDLINE、Embase 和 CENTRAL,截至 2021 年 5 月。纳入比较接受结直肠手术的患者与不给予术前碳水化合物负荷的患者的随机对照试验(RCT)。主要结局是血糖和胰岛素水平的变化。采用逆方差随机效应进行成对荟萃分析。

结果:检索得到 3656 条引文,其中纳入 12 项 RCT。共有 387 例接受术前碳水化合物负荷的患者(47.2%女性,年龄:62.0 岁)和 371 例对照组患者(49.4%女性,年龄:61.1 岁)纳入研究。两组患者的血糖和胰岛素水平无统计学差异。接受术前碳水化合物负荷的患者首次排气(SMD:-0.48 天,95%CI:-0.84 至-0.12,p=0.008)和排便(SMD:-0.50 天,95%CI:-0.86 至-0.14,p=0.007)的时间更短。此外,术前碳水化合物负荷组的住院时间更短(SMD:-0.51 天,95%CI:-0.88 至-0.14,p=0.007)。两组患者的术后发病率和患者舒适度无差异。

结论:术前碳水化合物负荷不会显著影响接受结直肠手术的患者的术后血糖控制;但可能与住院时间缩短和更快恢复肠道功能相关。考虑将其纳入结直肠术后恢复增强方案中。

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