Lai Yahao, Cai Yongrui, Ding Zichuan, Huang Chao, Luo Zeyu, Zhou Zongke
Department of Orthopaedic Surgery, West China Hospital of Sichuan University, Chengdu, China.
J Arthroplasty. 2025 Mar;40(3):665-671. doi: 10.1016/j.arth.2024.09.016. Epub 2024 Sep 16.
Many individuals undergoing surgery involving general anesthesia are asked to fast for a prolonged period to ensure perioperative safety, yet this can initiate stress reactions and insulin resistance, harming postoperative recovery. Such fasting may be particularly problematic for those who have type 2 diabetes. Here, we assessed how giving such individuals' oral carbohydrates before total knee arthroplasty can affect outcomes.
We randomized 90 patients who had non-insulin-dependent type 2 diabetes mellitus who were scheduled for elective total knee arthroplasty at one medical center between April 2022 and January 2023 to receive oral carbohydrates at two or four hours before surgery or to receive a carbohydrate-free "placebo" drink at four hours before surgery. The three groups were compared in terms of postoperative blood glucose, insulin resistance, β cell activity, postoperative wound complications, and other clinical outcomes.
The group who received oral carbohydrates at two or four hours before surgery showed significantly lower insulin resistance than the placebo group (group at two hours, 9.0 ± 3.4; group at four hours, 15.8 ± 6.9 versus placebo, 30.9 ± 10.5, P < 0.001) and lower β cell activity (207.7 ± 106.7%; group at four hours, 243.2 ± 114.9% versus 421.5 ± 209.3%, P < 0.001). Those groups were also significantly less likely than the placebo group to experience preoperative hunger or postoperative hyperglycemia. Among patients who received oral carbohydrates, those who received them two hours before surgery showed significantly lower insulin resistance and better glycemic control on postoperative day 1 than those who received carbohydrates four hours before surgery. None of the subjects developed intraoperative aspiration or experienced severe postoperative complications.
Oral carbohydrates at two to four hours before total knee arthroplasty are safe and can significantly alleviate preoperative hunger while mitigating postoperative insulin resistance and improving glycemic control in patients who have non-insulin-dependent type 2 diabetes mellitus.
许多接受全身麻醉手术的患者被要求长时间禁食以确保围手术期安全，但这可能引发应激反应和胰岛素抵抗，不利于术后恢复。对于2型糖尿病患者而言，这种禁食可能尤其成问题。在此，我们评估了在全膝关节置换术前给予此类患者口服碳水化合物会如何影响手术结果。
我们将2022年4月至2023年1月期间在某医疗中心计划接受择期全膝关节置换术的90例非胰岛素依赖型2型糖尿病患者随机分组，使其在术前两小时或四小时接受口服碳水化合物，或在术前四小时接受不含碳水化合物的“安慰剂”饮料。比较三组患者术后血糖、胰岛素抵抗、β细胞活性、术后伤口并发症及其他临床结果。
在术前两小时或四小时接受口服碳水化合物的组，其胰岛素抵抗显著低于安慰剂组（两小时组，9.0±3.4；四小时组，15.8±6.9，而安慰剂组为30.9±10.5，P<0.001），且β细胞活性较低（207.7±106.7%；四小时组，243.2±114.9%，而安慰剂组为421.5±209.3%，P<0.001）。与安慰剂组相比，这些组术前饥饿或术后高血糖的可能性也显著更低。在接受口服碳水化合物的患者中，术前两小时接受者术后第1天的胰岛素抵抗显著低于术前四小时接受者，血糖控制也更好。所有受试者均未发生术中误吸或出现严重术后并发症。
全膝关节置换术前两至四小时口服碳水化合物是安全的，可显著缓解术前饥饿，同时减轻非胰岛素依赖型2型糖尿病患者的术后胰岛素抵抗并改善血糖控制。
