Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, University of Zenica, Faculty of Medicine, Zenica, Bosnia and Herzegovina.
University Department for Anaesthesiology, Resuscitation and Intensive Care, Clinical Hospital Sveti Duh, Faculty of Medicine J.J. Strossmayer, Osijek, Croatia.
Eur Surg Res. 2023;64(2):278-285. doi: 10.1159/000530124. Epub 2023 Mar 20.
Preoperative carbohydrate oral (CHO) drinks attenuate the surgical stress response; however, the effects of CHO supplementation on the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory and immunology-based predictor remain unclear. This study evaluated the effects of preoperative CHO loading on NLR values and complications following open colorectal surgery compared with a conventional fasting protocol.
Sixty eligible participants having planned for routine and open colorectal cancer surgery from May 2020 to January 2022 were prospectively and randomly allocated to either the control (fasting) group, whose members discontinued oral intake beginning the midnight before surgery, or the intervention (CHO) group, whose members consumed a CHO solution the night before surgery and 2 h prior to anaesthesia. NLR was assessed at 06:00 h before surgery (baseline) and at 06:00 h on postoperative days 1, 3, and 5. The incidence and severity of postoperative complications were assessed by Clavien-Dindo Classification up to postoperative day 30. All data were analysed using descriptive statistics.
Postoperative NLR and delta NLR values were significantly higher in controls (p < 0.001; p < 0.001). Control group participants also demonstrated grade IV (n = 5; 16.7%, p < 0.01) and grade V (n = 1; 3.3%, p < 0.313) postoperative complications. There were no major postoperative complications in the CHO group.
Preoperative CHO consumption reduced postoperative NLR values and the incidence and severity of postoperative complications following open colorectal surgery, compared with a preoperative fasting protocol. Preoperative carbohydrate loading may improve recovery following colorectal cancer surgery.
术前口服碳水化合物（CHO）饮料可减轻手术应激反应；然而，CHO 补充对中性粒细胞与淋巴细胞比值（NLR）作为炎症和免疫学预测指标的影响尚不清楚。本研究评估了与传统禁食方案相比，术前 CHO 负荷对开放式结直肠手术后 NLR 值和并发症的影响。
2020 年 5 月至 2022 年 1 月期间，有计划接受常规和开放式结直肠癌手术的 60 名符合条件的参与者被前瞻性随机分配至对照组（禁食组）或干预组（CHO 组）。禁食组成员于手术前一天午夜停止口服摄入，CHO 组成员于手术前一晚和麻醉前 2 小时饮用 CHO 溶液。在手术前 06:00 h（基线）和术后第 1、3 和 5 天 06:00 h 评估 NLR。术后并发症的发生率和严重程度采用 Clavien-Dindo 分类法评估至术后第 30 天。所有数据均采用描述性统计进行分析。
对照组术后 NLR 和 delta NLR 值明显升高（p < 0.001；p < 0.001）。对照组参与者还表现出第 IV 级（n = 5；16.7%，p < 0.01）和第 V 级（n = 1；3.3%，p < 0.313）术后并发症。CHO 组无重大术后并发症。
与术前禁食方案相比，术前 CHO 摄入可降低开放式结直肠手术后的术后 NLR 值和术后并发症的发生率和严重程度。术前碳水化合物负荷可能会改善结直肠癌手术后的恢复。
