摘要
目的研究术前预防性口服碳水化合物对直肠癌腹腔镜手术患者术后胰岛素抵抗的影响。方法选择2014年4月至2017年4月在本院就诊的70例直肠癌腹腔镜手术患者作为研究对象,随机分为两组,每组各35例。观察组术前口服400 m L碳水化合物溶液,20 min内服完,对照组术前常规禁食、水。比较两组患者手术基本情况,手术前后空腹血糖(FPG)、血清胰岛素、胰岛素生长因子(IGF-1)、胰岛素抵抗和敏感指数,检测小肠和肝脏中G-6-Pase和PEPCK灰度值情况,比较两组患者住院期间并发症发生率。结果两组患者手术时间、术中出血量和补液量差异均无统计学意义(均P>0.05),观察组住院时间短于对照组(P<0.05)。两组患者术后FPG、空腹胰岛素、胰岛素抵抗指数较术前均升高(均P<0.05),胰岛素敏感指数较术前降低(P<0.05),观察组术后FPG、空腹胰岛素及胰岛素抵抗指数均低于对照组(均P<0.05),胰岛素敏感指数和IGF-1均高于对照组(均P<0.05)。观察组肝脏、小肠G-6-Pase和PEPCK灰度值均低于对照组(均P<0.05)。两组患者术中均无误吸、中转开腹及死亡病例,术后并发症总发生率差异无统计学意义(P>0.05)。结论直肠癌腹腔镜手术患者术前预防性口服碳水化化合物溶液能改善患者术后胰岛素抵抗情况,有利于患者早期康复,可能与碳水化合物减轻糖异生作用有关。
Objective To investigate the effect of prophylactic carbohydrate on postoperative insulin resistance in patients undergoing laparoscopic surgery for rectal cancer. Methods 70 patients with rectal cancer who underwent laparoscopic surgery in our hospital from April 2014 to April 2017 were recruited as the research subjects and were randomly assigned into two groups, with 35 patients in each group. The patients in the treatment group received 400 ml carbohydrate solution by oral intake, which was finished within 20 minutes, before operation, and the control group were treated with routine fasting and were required to refrain from fluid before operation. Indices related to operation, and levels of fasting plasma glucose（FPG）, serum insulin, insulin growth factor-1（IGF-1）, insulin resistance and sensitivity index before and after operation were compared between the two groups. The gray values of G-6-Pase and PEPCK in the small intestine and liver were detected. Incidence of complications during hospitalization were recorded and compared in the two groups. Results There was no significant difference in operation duration, amount of intraoperative blood loss and fluid infusion between the two groups（P〈0.05）. Hospitalization duration was shorter in the treatment group than in the control group（P〈0.05）.In both groups, levels of FPG, fasting insulin and insulin resistance index increased, whle insulin sensitivity index decrease from before to after operation（P〈0.05）. After operation, levels of FPG, fasting insulin and insulin resistance index were significantly lower and insulin sensitivity index and IGF-1 higher in the treatment group than in the control group（P〈0.05）. The G-6-Pase and PEPCK gray values in liver and small intestinal were lower in the treatment group than those of the control group（P〈0.05）. There were no aspiration, conversion to laparotomy and death in both groups. There was no significant difference in the total incidence of postoperative complications between the t
作者
易钢锋
胡卫军
田文昊
赵亚东
Yi Gangfeng;Hu Weijun;Tian Wenhao;Zhao Yadong(Department of General Surgery,Xi＇an First Hospital,Xi＇an,Shaanxi,710002,China;Department of General Surgery,Affiliated Hospital of Yan＇an University,Yan＇an,Shaanxi,716000,China)
出处
《结直肠肛门外科》
2018年第4期336-340,共5页
Journal of Colorectal & Anal Surgery
基金
陕西省自然科学基金计划项目(编号:ZR201604021)
