【摘要】 目的评价高龄患者髋关节置换术前口服碳水化合物的安全性及对术后胰岛素抵抗的影响。方法选择2013年3月~2014年10月,择期行髋关节置换术高龄患者120例,随机分为碳水化合物组(n=40)、安慰剂组(n=40)和禁饮组(n=40)。碳水化合物组麻醉前2~3 h口服500 m L碳水化合物,安慰剂组口服同等量蒸馏水,禁饮组术前常规禁饮。分别检测患者术前1 d、麻醉前、术后第1天和第3天的血糖、胰岛素水平,利用稳态模式评估法(HOMA)测定胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(HOMA-ISI),同时比较三组患者的主观舒适度、胃内残留量及切口愈合。结果碳水化合物组术前1 h饥饿感[(13.27±8.31)分]低于安慰剂组[(31.43±10.46)分]和禁饮组[(29.83±9.25)分](P<0.01),切口愈合情况更佳(P<0.05);三组胃内残留量比较,差异无统计学意义(P>0.05)。碳水化合物组术后第1天的HOMA-IR[(3.28±0.29)]明显低于安慰剂组[(14.97±0.57)]和禁饮组[(16.15±0.72)](P<0.01),而HOMA-ISI[(13.56±1.03)]则显著高于安慰剂组[(2.97±0.11)]和禁饮组[(2.75±0.09)](P<0.01)。结论高龄患者髋关节置换术前口服碳水化合物安全有效,可明显缓解术前的口渴感和饥饿感及减轻术后胰岛素抵抗,有助于患者术后切口的愈合。更多还原

【Abstract】 Objective To investigate the effects of oral intake of carbohydrate before surgery on the perioperative safety and postoperative insulin resistance in elderly patients undergoing hip arthroplasty. Methods From March 2013 to October 2014, 120 elderly patients who were going to get elective hip arthroplasty were selectd and divided randomly into three groups: oral carbohydrate group(n = 40), oral placebo group(n = 40) and water deprivation group(n = 40). 500 m L carbohydrate was administrated orally 2-3 hours before anesthesia in oral carbohydrate group. Patients in the oral placebo group were given distilled water instead of carbohydrate. A routine preoperative fasting was recommended for patients in water deprivation group. The levels of blood glucose(BG) and plasma insulin(INS) were tested on the day before operation, the time before anesthesia, one day and three day after operation. According to levels of BG and INS,homeostasis model assessment(HOMA) was applied to calculate the index of insulin resistance(OMAIR) and insulin sensitivity index(HOMAISI). Meanwhile, patients’ wellbeing scores, gastric residues before anesthesia and the healing of surgical incisions were also recorded. Results Relieved hunger before anesthesia 1 h of oral carbohydrate group[(13.27±8.31) points] was less than oral placebo group [(31.43±10.46) points] and water deprivation group [(29.83±9.25)points], the difference was statistically significant(P < 0.01); and oral carbohydrate group had better healing of the surgical incision(P < 0.05); there was no significant differences of gastric residues among these groups(P > 0.05). The HOMAIR levels at the 1st day after operation in the oral carbohydrate group [(3.28±0.29)] was lower than those of oral placebo group [(14.97±0.57)] and water deprivation group [(16.15±0.72)](P < 0.01); conversely, the HOMA-ISI levels in the oral carbohydrate group(13.56±1.03) was higher than those in oral placebo group [(2.97±0.11)] and water deprivation group[(2.75±0.09)](P < 0.01). Conclusion Preoperative oral intake of carbohydrate can safely reduce the insulin resistance and relieve the feelings of thirst and hunger, and this method is helpful to the healing of surgical incisions.更多还原