Yadav Kavita, Prakash Ravi, Singh Gyan Prakash, Gautam Shefali, Arshad Zia, Singh Brijesh P
Anesthesiology, King George's Medical University, Lucknow, IND.
Cureus. 2023 Sep 2;15(9):e44570. doi: 10.7759/cureus.44570. eCollection 2023 Sep.
Investigations of preoperative oral carbohydrate (CHO) loading have primarily examined benefits among patients without diabetes. Preoperative CHO-rich beverages in general populations have resulted in reductions in insulin resistance after surgery, protein loss, metabolic derangements, and immune dysfunction. The aim of this study was to assess the effect of CHO loading in diabetic patients undergoing laparoscopic cholecystectomy.
Diabetic patients controlled on oral hypoglycemic agent were randomly divided into two groups: (1) Group T - this group will be given 50 g of maltodextrin before two hours of surgery; (2) Group C - this group will be kept nil per oral as per standard protocol. Blood sugar, serum insulin, serum cortisol, and insulin requirement were compared in both groups.
Blood sugar levels of Group C were found to be significantly higher than that of Group T at six hours and 24 hours. In Group T, a rise in baseline serum insulin (8.94 ± 3.43 mIU/l) was observed at 24 hours (13.23 ± 5.71 mIU/l). A change of 4.29 ± 3.00 mIU/l in serum insulin level was observed. The change in baseline serum insulin levels was 47.99%. In Group C too, a rise in baseline serum insulin (6.27 ± 1.74 mIU/l) was observed at 24 hours (18.00 ± 5.34 mIU/l). A change of 11.73 ± 4.97 mIU/l in serum insulin level was observed. The change in baseline HOMA-IR (homeostatic model assessment for insulin resistance) levels in Group T was 53.66%. A rise (4.39 ± 1.63) in baseline HOMA-IR of Group C (1.65 ± 0.45) was observed at 24 hours (6.04 ± 1.76). The change in baseline HOMA-IR levels in Group C was 266.06%.
CHO loading is observed to be beneficial in diabetic patients undergoing laparoscopic cholecystectomy. No adverse effects or an increased risk of aspiration were observed in the intervention group during the study period.
术前口服碳水化合物（CHO）负荷的研究主要集中在非糖尿病患者中。普通人群术前饮用富含CHO的饮料可降低术后胰岛素抵抗、蛋白质丢失、代谢紊乱和免疫功能障碍。本研究旨在评估CHO负荷对接受腹腔镜胆囊切除术的糖尿病患者的影响。
口服降糖药控制的糖尿病患者随机分为两组：（1）T组——该组在手术前两小时给予50克麦芽糊精；（2）C组——该组按照标准方案口服无食物。比较两组的血糖、血清胰岛素、血清皮质醇和胰岛素需求量。
发现C组血糖水平在6小时和24小时时显著高于T组。在T组中，24小时时基线血清胰岛素（8.94±3.43 mIU/l）升高（13.23±5.71 mIU/l）。血清胰岛素水平变化为4.29±3.00 mIU/l。基线血清胰岛素水平变化为47.99%。在C组中，24小时时基线血清胰岛素（6.27±1.74 mIU/l）也升高（18.00±5.34 mIU/l）。血清胰岛素水平变化为11.73±4.97 mIU/l。T组基线HOMA-IR（胰岛素抵抗稳态模型评估）水平变化为53.66%。C组基线HOMA-IR（1.65±0.45）在24小时时升高（4.39±1.63）（6.04±1.76）。C组基线HOMA-IR水平变化为266.06%。
观察到CHO负荷对接受腹腔镜胆囊切除术的糖尿病患者有益。研究期间干预组未观察到不良反应或误吸风险增加。
