您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (9): 48-53.doi: 10.6040/j.issn.1671-7554.0.2019.527

• • 上一篇    

术前口服多糖溶液对结直肠癌患者术后胰岛素抵抗的关联性研究

吴成威,孙博实,周军德,蒋天明,迟强   

  1. 哈尔滨医科大学附属第二医院普外科, 黑龙江 哈尔滨 150081
  • 发布日期:2022-09-27
  • 通讯作者: 迟强. E-mail:qiangchi61@126.com
  • 基金资助:
    国家自然科学基金青年科学基金(81802990)

Association between preoperative oral polysaccharide solution and insulin resistance in patients with colorectal cancer

WU Chengwei, SUN Boshi, ZHOU Junde, JIANG Tianming, CHI Qiang   

  1. Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang, China
  • Published:2022-09-27

摘要: 目的 通过对比择期结直肠癌患者术前口服多糖溶液及安慰剂的术后胰岛素抵抗及并发症情况,探讨其安全性、可行性及优势。 方法 将2017年4月至2018年12月哈尔滨医科大学附属第二医院普外科的病历资料进行回顾分析,80例结直肠癌患者包括多糖溶液组40例与对照组(安慰剂组)40例。比较两组患者的一般资料、稳态模型2胰岛素抵抗指数(HOMA2-IR)、稳态模型2胰岛素敏感指数(HOMA2-%S)、空腹血糖(FPG)、空腹胰岛素(FINS)、白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、术后并发症等情况,并进行统计学分析。 结果 (1)两组患者的一般资料差异无统计学意义,术中均未出现误吸。(2)两组患者术后FPG、FINS、HOMA2-IR均较术前升高,HOMA2-%S降低(P<0.05)。(3)多糖溶液组患者术后第1、3天的空腹血糖、空腹胰岛素、胰岛素抵抗指数小于对照组,胰岛素敏感指数高于对照组(P<0.05)。(4)多糖溶液组患者术后白细胞、C反应蛋白较对照组低(P<0.05)。(5)多糖溶液组患者术后首次排气时间早于对照组(P<0.05)。(6)两组患者在术后感染性并发症、住院时间、住院费用方面差异无统计学意义(P>0.05)。 结论 与对照组相比,术前口服多糖溶液不增加误吸风险,而且能显著降低术后胰岛素抵抗、增加胰岛素敏感性、促进肠道功能恢复,但是在住院时间、住院费用及并发症方面并无明显差异。

关键词: 多糖溶液, 碳水化合物, 结直肠癌, 胰岛素抵抗, 并发症

Abstract: Objective To explore the safety, feasibility and advantages of preoperative oral polysaccharide solution by comparing postoperative insulin resistance and complications between preoperative oral polysaccharide solution and placebo for patients undertaking elective colorectal surgery. Methods The clinical data of 80 patients with colorectal cancer treated during Apr. 2017 and Dec. 2018 were retrospectively analyzed, including 40 patients in the polysaccharide solution group and 40 in the control group(placebo group). The general data, homeostasis model assessment-2 insulin resistance index(HOMA2-IR), homeostasis model assessment-2 insulin sensitivity index(HOMA2-%S), fasting plasma glucose(FPG), fasting insulin(FINS), white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT), and postoperative complications were compared between the two groups. Results (1) There were no statistical differences in the general data between the two groups and no aspiration occurred during operation. (2) The FPG, FINS and HOMA2-IR of both groups increased after operation, while HOMA2-%S decreased(P<0.05). (3) The polysaccharide solution group had lower FPS, FINS and HOMA2-IR but higher HOMA2-%S on the 1st and 3rd postoperative day(POD1, POD3)than the control group(P<0.05). (4) The polysaccharide solution group had lower postoperative WBC 山 东 大 学 学 报 (医 学 版)57卷9期 -吴成威,等.术前口服多糖溶液对结直肠癌患者术后胰岛素抵抗的关联性研究 \=-and CRP(P<0.05). (5) The polysaccharide solution group had shorter first anus exhausting time(P<0.05). (6) There were no significant differences in postoperative infectious complications, length of stay(LOS)and hospitalization costs between the two groups(P>0.05). Conclusion Compared with the placebo, preoperative oral polysaccharide solution does not increase the risk of aspiration. Instead, it significantly reduces insulin resistance, increases insulin sensitivity, and promotes the recovery of intestinal function. However, there are no significant differences in the length of stay, hospitalization costs and complications between the usage of placebo and polysaccharide solution.

Key words: Polysaccharide solution, Carbohydrate, Colorectal cancer, Insulin resistance, Complications

中图分类号: 

  • R656
[1] Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia[J]. Am J Obstet Gynecol, 1946, 52: 191-205.
[2] Thorell A, Efendic S, Gutniak M, et al. Insulin resistance after abdominal surgery[J]. Br J Surg, 1994, 81(1): 59-63.
[3] Thorell A, Efendic S, Gutniak M, et al. Development of postoperative insulin resistance is associated with the magnitude of operation[J]. Eur J Surg, 1993, 159(11-12): 593-599.
[4] Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy[J]. Curr Opin Anaesthesiol, 2015, 28(3): 364-369.
[5] Çakar E, Yilmaz E, Çakar E, et al. The effect of preoperative oral carbohydrate solution intake on patient comfort: a randomized controlled study[J]. J Perianesth Nurs, 2017, 32(6): 589-599.
[6] Tudor-Drobjewski BA, Marhofer P, Kimberger O, et al. Randomised controlled trial comparing preoperative carbohydrate loading with standard fasting in paediatric anaesthesia[J]. Br J Anaesth, 2018, 121(3): 656-661.
[7] Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617.
[8] 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20.
[9] Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery(ERAS)society recommendations: 2018[J]. World J Surg, 2019, 43(3): 659-695.
[10] 郭晶, 邬维娜, 蔡学联, 等. 医务人员禁食禁饮方案实践指南的认知及依从现状调查[J]. 中华现代护理杂志, 2017, 23(35): 4460-4464. GUO Jing, WU Weina, CAI Xuelian, et al. Cognition and compliance of medical staff on fasting and water deprivation scheme from practice guideline[J]. Chinese Journal of Modern Nursing, 2017, 23(35): 4460-4464.
[11] 孙志坚, 孙旭, 孙伟桐, 等. 我国创伤骨科医生围手术期饮食管理现状调查[J]. 中华创伤骨科杂志, 2018, 20(8): 683-688. SUN Zhijian, SUN Xu, SUN Weitong, et al. Perioperative fasting management by traumatic surgeons in China[J]. Chinese Journal of Orthopaedic Trauma, 2018, 20(8): 683-688.
[12] Falconer R, Skouras C, Carter T, et al. Preoperative fasting: current practice and areas for improvement[J]. Updates Surg, 2014, 66(1): 31-39.
[13] Worknehe A, Ambrose R, Alula BN, et al. Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana[J]. Pan Afr Med J, 2016, 23:102. doi: 10.11604/pamj.2016.23.102.8863.
[14] Thorell A, Nygren J, Ljungqvist O. Insulin resistance: a marker of surgical stress[J]. Curr Opin Clin Nutr Metab Care, 1999, 2(1): 69-78.
[15] Shohat N, Muhsen K, Gilat R, et al. Inadequate glycemic control is associated with increased surgical site infection in total joint arthroplasty: a systematic review and meta-analysis[J]. J Arthroplasty, 2018, 33(7): 2312-2321.
[16] Wang Y, Hu S, Ying H, et al. Postoperative tight glycemic control significantly reduces postoperative infection rates in patients undergoing surgery: a meta-analysis[J]. BMC Endocr Disord, 2018, 18(1): 42. doi: 10.1186/s12902-018-0268-9.
[17] Lachmann G, Wollersheim T, Spies C. Severe perioperative hyperglycemia attenuates postoperative monocytic function, basophil count and T cell activation[J]. Minerva Anestesiol, 2017, 83(9): 921-929.
[18] Mraovic B, Suh D, Jacovides C, et al. Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty[J]. J Diabetes Sci Technol, 2011, 5(2): 412-418.
[19] Mesotten D, Preiser JC, Kosiborod M. Glucose management in critically ill adults and children[J]. Lancet Diabetes Endocrinol, 2015, 3(9): 723-733.
[20] Gianotti L, Biffi R, Sandini M, et al. Preoperative oral carbohydrate load versus placebo in major elective abdominal surgery(PROCY): a randomized, placebo-controlled, multicenter, phase III trial[J]. Ann Surg, 2018, 267(4): 623-630.
[21] Gustafsson UO, Nygren J, Thorell A, et al. Pre-operative carbohydrate loading may be used in type 2 diabetes patients[J]. Acta Anaesthesiol Scand, 2008, 52(7): 946-951.
[22] Näveri H, Tikkanen H, Kairento AL, et al. Gastric emptying and serum insulin levels after intake of glucose-polymer solutions[J]. Eur J Appl Physiol Occup Physiol, 1989, 58(6): 661-665.
[23] Esaki K, Tsukamoto M, Sakamoto E, et al. Effects of preoperative oral carbohydrate therapy on perioperative glucose metabolism during oral-maxillofacial surgery: randomised clinical trial[J]. Asia Pac J Clin Nutr, 2018, 27(1): 137-143.
[24] Thiele RH, Raghunathan K, Brudney CS, et al. American society for enhanced recovery(ASER)and perioperative quality initiative(POQI)joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery[J]. Perioper Med, 2016, 5(1): 24. doi: 10.1186/s13741-016-0049-9.
[25] Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emptying. Effects of anxiety and oral carbohydrate administration [J]. Ann Surg, 1995, 222(6): 728-734.
[1] 张媛 李英敏 冯月秋 常彩云 潘华伟 王束玫. 血清脂联素水平与肥胖、胰岛素抵抗的关系探讨[J]. 山东大学学报(医学版), 2209, 47(6): 124-.
[2] 王艳莉,冯晔,周秀耕,杨跃,吴楠,方玉,阎石,李少雷,吕超,韩超,杜松涛. 33例食管癌患者围术期补充乳清蛋白粉对术后并发症的预防作用[J]. 山东大学学报 (医学版), 2022, 60(3): 64-70.
[3] 林均馨,刘玉江,刘培来,万连平,张鹏,杜建春,刘泽淼,孔杰,高升焘. 固定平台单髁术后胫骨假体周围骨折2例[J]. 山东大学学报 (医学版), 2022, 60(3): 96-99.
[4] 张建平,罗莺儿. 抗凝药物在反复不良妊娠治疗中的应用进展[J]. 山东大学学报 (医学版), 2021, 59(8): 14-19.
[5] 邹俊逸,张辉,张歆杰,李子佳,许明雷,王东. 110例原位心脏移植临床经验[J]. 山东大学学报 (医学版), 2021, 59(8): 86-91.
[6] 孙富云,王维鹏,张会会,耿艳,安小霞,李双双,张彬彬. 结直肠癌术后患者人格特质与抑郁、焦虑症状的关联性[J]. 山东大学学报 (医学版), 2021, 59(7): 91-96.
[7] 牛群,石婧婧,符江. WNT5A基因对卵巢颗粒细胞胰岛素反应性和胰岛素抵抗的调控作用[J]. 山东大学学报 (医学版), 2021, 59(6): 57-63.
[8] 罗应舒,李宾,许昌芹,姜军梅,许洪伟. 240例上消化道黏膜下肿瘤内镜治疗的疗效及并发症评估[J]. 山东大学学报 (医学版), 2021, 59(3): 74-80.
[9] 哈灵侠,殷婷,吴阳阳,黎维霞,杜玉冬. 多囊卵巢综合征患者中胰岛素抵抗与子宫内膜局部炎症因子及葡萄糖转运蛋白-4表达的相关性[J]. 山东大学学报 (医学版), 2021, 59(11): 41-47.
[10] 杜甜甜,李娟,赵颖慧,段伟丽,王景,王允山,杜鲁涛,王传新. 长链非编码RNA LINC02474在结直肠癌中的表达特征及对细胞增殖的影响[J]. 山东大学学报 (医学版), 2021, 59(10): 57-67.
[11] 郭志华,赵大庆,邢园,王薇,梁乐平,杨静,赵倩倩. Ⅰ期端端吻合术治疗重度颈段气管狭窄临床分析[J]. 山东大学学报 (医学版), 2020, 1(7): 72-76.
[12] 李宁,李娟,谢艳,李培龙,王允山,杜鲁涛,王传新. 长链非编码RNA AL109955.1在80例结直肠癌组织中的表达及对细胞增殖与迁移侵袭的影响[J]. 山东大学学报 (医学版), 2020, 1(7): 38-46.
[13] 李乐平,崔怀平,商亮. 加速康复外科在胃肠外科手术中的应用[J]. 山东大学学报 (医学版), 2019, 57(9): 5-11.
[14] 郭艳,张哲莹,王云溪,魏小娟. 人源性长寿保障基因2在结直肠癌组织中的表达及其临床意义[J]. 山东大学学报 (医学版), 2019, 57(7): 67-71.
[15] 王冰. 腰椎完全内镜经椎板间入路技术的临床教程[J]. 山东大学学报 (医学版), 2019, 57(5): 23-29.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!