输注果糖与葡萄糖注射液对术后患者糖代谢的影响

目的:对果糖与葡萄糖注射液在术后应激状况下缓解高血糖反应并提供热量的有效性及安全性进行比较与评价。方法:采用多中心、随机、盲法、阳性药物平行对照的方法,在124例外科术后患者中,随机分成两组,连续3天每天各给予10%果糖注射液或10%葡萄糖注射液750ml静脉滴注,比较两种碳水化合物输注液对机体糖代谢与胰岛素分泌的影响。结果:实验组(64例)在静脉输注葡萄糖液后,血糖水平显著增高;对照组(60例)给予10%果糖注射液,血糖水平较前无明显升高,输注果糖时,血糖水平明显低于输注葡萄糖液时,两组比较差异有统计学意义(P<0.01)。输注葡萄糖注射液后血胰岛素显著增高,输注果糖注射液后血胰岛素无明显增加,组间比较差异有显著性(P<0.01)。用药3天二组患者的肝肾功能未见有临床意义的显著改变,不良反应发生率果糖组与葡萄糖组分别为1.56%与1.67%,组间比较,差异无显著性。结论:术后患者中应用10%果糖注射液,在补充液体提供碳水化合物能源同时可避免加剧应激后高血糖反应,对胰岛的功能影响较小,提示在手术后使用果糖注射液,可以避免应激情况下的高血糖反应与减少胰岛素分泌。

Effects parenteral fructose or glucose infusion on metabolic changes in post-operative patients

Objective: To evaluate the effects of parenteral infusion of fructose or glucose on metabolic changes in post-operative patients. Methods:A polycentric, double blind and randomized clinical trial was conducted in 124 post-operative patients. The patients were divided in two groups, and fructose solution(10%,750 ml) or glucose solution(10%,750 ml) were infused intravenously affer operation. Serum glucose and insulin level were monitored to evaluate the metabolic responses to different parenteral protocols. Results:Infusion of glucose increased in insulin activity, however fructose infusion had no such effects. Conclusion:Parenteral fructose, has a significantly less adverse impact than glucose on the glucose balance in the post-operative state. The benefits of fructose-specific metabolic effects suggest that fructose is an important nutrient that contributes to metabolic stabilization, especially in the post-operation phase and in trauma patients.