Sebestyén Anna Réka, Turan Caner, Szemere Ambrus, Virág Marcell, Ocskay Klementina, Dembrovszky Fanni, Szabó László, Hegyi Péter, Engh Marie Anne, Molnár Zsolt
Centre for Translational Medicine, Semmelweis University, Budapest, 1085, Üllői út 26, Hungary.
Heim Pál National Pediatric Institute, Budapest, Hungary.
Sci Rep. 2025 May 31;15(1):19119. doi: 10.1038/s41598-025-00767-z.
Preoperative fasting is a worldwide routine even though the most recent Enhanced Recovery After Surgery (ERAS) Guidelines recommend preoperative carbohydrate loading instead of fasting, but with low quality of evidence. Our aim was to compare the effects of preoperative carbohydrate loading to fasting and placebo in patients undergoing elective major non-cardiac surgery under general anaesthesia. Our systematic search was conducted on 15th of October 2021 in five databases, Medline, Embase, Central, Web of Science and Scopus, and updated on November 12th, 2024. We included randomized controlled trials that compared the carbohydrate loading (CHO-group) with fasting or with placebo. Main outcomes were length of hospital stay (LOS), postoperative glucose levels on postoperative, postoperative insulin levels, and C-reactive protein (CRP) levels. Our search revealed 44 eligible articles for data extraction. LOS was shorter in the CHO group as compared to the No-CHO group (MD: - 0.56 [95% CI: - 1.10, - 0.02]). There were no clinically significant differences between the CHO and No-CHO groups regarding the postoperative glucose, insulin and CRP levels. This meta-analysis found that preoperative CHO-loading as compared to preoperative fasting or placebo shortened the length of hospital stay in patients undergoing major elective, non-cardiac surgery. Although several details are still to be unveiled, these data provide further support that preoperative carbohydrate loading could be beneficial in this patient population.
术前禁食是一项全球通行的常规做法，尽管最新的《术后加速康复（ERAS）指南》建议术前进行碳水化合物负荷补充而非禁食，但证据质量较低。我们的目的是比较术前碳水化合物负荷补充与禁食及安慰剂对接受全身麻醉的择期非心脏大手术患者的影响。我们于2021年10月15日在五个数据库（Medline、Embase、Central、科学网和Scopus）中进行了系统检索，并于2024年11月12日进行了更新。我们纳入了比较碳水化合物负荷补充组（CHO组）与禁食组或安慰剂组的随机对照试验。主要结局指标为住院时间（LOS）、术后血糖水平、术后胰岛素水平和C反应蛋白（CRP）水平。我们的检索发现了44篇符合数据提取条件的文章。与非CHO组相比，CHO组的住院时间更短（MD：-0.56 [95% CI：-1.10，-0.02]）。CHO组和非CHO组在术后血糖、胰岛素和CRP水平方面无临床显著差异。这项荟萃分析发现，与术前禁食或安慰剂相比，术前进行碳水化合物负荷补充可缩短接受择期非心脏大手术患者的住院时间。尽管仍有一些细节有待揭示，但这些数据进一步支持术前碳水化合物负荷补充可能对该患者群体有益。
