肝癌手术术前口服碳水化合物的安全性及疗效评估:随机对照研究

【摘要】〓目的〓本研究的目的旨在了解择期肝癌手术患者术前口服碳水化合物的安全性及其对术后应激性高血糖及胰岛素抵抗的影响。方法〓61例符合原发性肝癌患者入组,按照随机表法随机分为实验组和对照组。实验组的患者术前3小时口服10%的葡萄糖250 mL,对照组的患者则按照传统术前准备。比较2组患者术中胃液量及围手术期血糖、血胰岛素和稳态模型的胰岛素抵抗指数(HOMA-IR)的变化情况。结果〓两组患者均未见1例误吸发生。实验组和对照组的胃液量分别为45.4±18.4 mL和38.8±17.2 mL,差异未见显著的统计学意义。两组患者术前的一般资料、肝功能、血糖、胰岛素和HOMA-IR水平相近。尽管术后第5天两组患者的肝功能指标相近,但研究组术后第1天和第3天的AST、ALT和总胆红素水平明显低于对照组;而且研究组的患者术后第1天、第3天和第5天的空腹血糖、胰岛素和HOMA-IR水平均明显低于对照组,差异具有统计学意义。结论〓本研究发现术前3小时口服10%的葡萄糖250 mL安全可靠,并显著降低术后应激性高血糖和胰岛素抵抗的发生。

The safety and clinical effect of preoperative oral carbohydrate intaking on primary liver cancer surgery: a randomized control trial

【Abstract】〓Objective〓To investigate the safety of preoperative oral carbohydrate loading and the effect on postoperative stress hyperglycemia as well as insulin resistance after elective liver cancer. Methods〓Sixty-one cases with liver cancer undergoing elective liver surgery were randomized into experimental group and control group. The patients in the experimental group were given 10% glucose 250 ml oral drink three hours before operation, while the ones in the control group were fasted overnight. The volume of gastric juices and perioperative blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) were recorded and analyzed. Results〓None was found to have aspiration. The average gastric juice of experimental group and control group was 45.4±18.4 ml and 38.8±17.2 ml and no statistical difference was found between two groups. There were no significant difference between two groups in preoperative general information, liver function, blood glucose, insulin and HOMA-IR level (P>0.05). The liver function in the postoperative 5 days were similar between two groups, and the level of AST, ALT and total serum bilirubin were significantly lower in the experimental group in the postoperative 1 and 3 days (P<0.05). Moreover, the levels of fasting blood glucose, insulin, HOMA-IR in the experimental group were statistically lower in the postoperative 1, 3 and 5 days (P<0.05). Conclusion〓Ten percent glucose of 250 ml oral administration in 3 hours before operation was safe and it can significantly reduced postoperative stress hyperglycemia and insulin resistance.