糖预处理对体外循环中胃肠激素和糖代谢的影响

目的探讨糖预处理对体外循环(CPB)中糖代谢和胃肠激素的影响。方法 30例心脏直视手术患者分为两组,糖预处理组(Ⅰ组,n=15),对照组(Ⅱ组,n=15)。Ⅰ组于术前3 h口服无渣饮料200 ml(含糖50 g),Ⅱ组禁饮食方法按外科常规进行。两组患者分别在麻醉前、CPB前、CPB 15 min、开放升主动脉后5 min、停止CPB 20 min和术后3 h,测定红细胞比容和血糖浓度,放射免疫法测定胰岛素、胃泌素和胃动素浓度。胰岛素敏感性指数为同一血样胰岛素浓度与血糖浓度乘积的倒数。结果 CPB期间Ⅰ组围术期血糖浓度波动较小,术后胰岛素敏感性下降较Ⅱ组轻(P0.05)。两组患者术中及术后胃泌素和胃动素浓度均高于麻醉前(P0.05)。CPB中Ⅰ组胃泌素浓度均低于Ⅱ组(P0.05),Ⅰ组的胃动素浓度也比Ⅱ组有所降低,但除开放升主动脉后5 min外,两组无显著差异。结论在CPB心脏手术期间采用术前糖预处理,能够在一定程度上减轻胃肠激素分泌紊乱的程度,改善糖代谢。

Effect of preoperative carbohydrate loading on gastrointestinal hormone and glucose metabolism during cardiopulmonary bypass

OBJECTIVE To investigate the effect of preoperative carbohydrate loading on gastrointestinal hormone and glucose metabolism during the perioperation of cardiopulmonary bypass（CPB）.METHODS 30 patients were divided into two groups： Experimental group（preoperative carbohydrate loading,n=15） and control group（preoperative fasting,n=15）.Blood samples were obtained respectively at the following intervals： before anesthesia,before CPB,CPB 15 minutes,5 minutes after unclamping aorta,20 minutes after CPB and 3 hours after operation.Motilin（MOT）,Gastrin（Gas） and Insulin were measured by radioimmunoassay.Insulin sensitivity index were obtained by calculating.RESULTS Fluctuations of perioperative blood glucose were slightly and postoperative decline of insulin sensitivity was light in experimental group（P〈0.05）.Two groups of patients with intraoperative and postoperative gastrin and motilin concentrations were higher than those before anesthesia.Gastrin concentrations in experimental group were lower than the control group.The motilin concentrations in experimental group were slightly lower than the control group,except at 5 minutes after unclamping aorta,there was no significant difference between the two groups.CONCLUSION Preoperative carbohydrate loading could improve gastrointestinal hormone secretion disorder and abnormal glucose metabolism during extracorporeal circulation.