术前口服碳水化合物对腹腔镜胆囊切除术患者胰岛素抵抗的影响：一项随机对照试验。
Effect of preoperative oral carbohydrates on insulin resistance in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial.
机构信息
Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, Jiangsu, China.
出版信息
Langenbecks Arch Surg. 2024 Feb 27;409(1):77. doi: 10.1007/s00423-024-03268-1.
PURPOSE
The present research seeks to clarify the consequences of two specific preoperative oral carbohydrate (POC) amounts on insulin resistance (IR) and stomach evacuation in laparoscopic cholecystectomy (LC) patients.
METHODS
A total of 129 patients set for elective LC procedures were randomly assigned to a control group (C, n = 45), a 200 mL POC group (P1, n = 42), and a 400 mL POC group (P2, n = 42). The C group was fasted from midnight until surgery, whereas the P1 and P2 groups received their respective carbohydrate volumes 2-4 h before anesthesia. Fasting blood glucose, insulin, and glucagon concentrations were measured at three junctures. IR metrics were derived by employing the homeostasis model assessment. Gastric volume was measured before anesthesia using gastric ultrasound. Inter-group comparisons included IR indicators, subjective comfort scores, and hemodynamic data.
RESULTS
At T2, the C group exhibited reduced glucose concentrations compared to the P2 group (4.73 ± 0.64 vs. 5.26 ± 1.02 mmol/L, p < 0.05). The Perlas grading indicated that grade 1 was more prevalent in the P2 group than in the P1 and C groups (18 [42.9%] vs. 6 [14.3%] and 1 [2.2%], p < 0.05). Additionally, thirst and hunger metrics for the P2 group were notably reduced compared to the C group at both T2 and T3.
CONCLUSION
Administering either 200 mL or 400 mL of carbohydrates 2-4 h pre-surgery had no detectable impact on IR or gastric volume in LC patients.
TRIAL REGISTRATION
ChiCTR, ChiCTR2200065648. Registered January 13, 2023, http://www.chictr.org.cn .
目的
本研究旨在阐明两种特定术前口服碳水化合物（POC）量对腹腔镜胆囊切除术（LC）患者胰岛素抵抗（IR）和胃排空的影响。
方法
共有 129 例拟行择期 LC 手术的患者被随机分为对照组（C 组，n=45）、200ml POC 组（P1 组，n=42）和 400ml POC 组（P2 组，n=42）。C 组从午夜开始禁食至手术，而 P1 和 P2 组则在麻醉前 2-4 小时内给予各自的碳水化合物量。在三个时间点测量空腹血糖、胰岛素和胰高血糖素浓度。采用稳态模型评估法得出 IR 指标。在麻醉前使用胃超声测量胃容量。组间比较包括 IR 指标、主观舒适度评分和血流动力学数据。
结果
在 T2 时，C 组的血糖浓度较 P2 组降低（4.73±0.64 vs. 5.26±1.02mmol/L，p<0.05）。Perlas 分级显示 P2 组的 1 级比例高于 P1 组和 C 组（18[42.9%] vs. 6[14.3%]和 1[2.2%]，p<0.05）。此外，与 C 组相比，P2 组在 T2 和 T3 时的口渴和饥饿评分均显著降低。
结论
术前 2-4 小时给予 200ml 或 400ml 碳水化合物对 LC 患者的 IR 或胃容量无明显影响。
试验注册
ChiCTR，ChiCTR2200065648。于 2023 年 1 月 13 日注册，http://www.chictr.org.cn。
Zotero 插件