术前碳水化合物对瘢痕切除术后胰岛素抵抗的影响

Effect of preoperative carbohydrate supplementation on insulin resistance in patients after scar ectomy

目的观察术前口服碳水化合物及静脉输注葡萄糖对术后胰岛素抵抗程度的影响。方法择期瘢痕切除术病人60例,随机分为对照组、口服组和静注组,每组20例。术前对照组常规禁食禁饮;口服组口服12.5%碳水化合物的饮料(CHO);静注组持续静脉输注10%葡萄糖液。分别于口服或静注前、术后6 h采血,测定血糖、血清胰岛素以及红细胞胰岛素受体。结果处理前各组血糖、血清胰岛素、胰岛素敏感指数及红细胞胰岛素高亲和力受体、低亲和力受体无明显差异;术后6 h口服组、静注组的血糖明显低于对照组,与处理前无显著差别;术后6 h各组血清胰岛素无显著差别,均显著高于处理前;胰岛素敏感指数、红细胞低亲和力受体三组均较处理前显著降低,但口服组、静注组明显高于对照组;术后6 h口服组、静注组红细胞高亲和力受体无明显降低;口服组与静注组间的血糖、胰岛素、胰岛素敏感指数及红细胞胰岛素受体无明显差别。结论术前静脉输注葡萄糖可缓解术后胰岛素抵抗的程度,术前饮用碳水化合物具有同样的效果,是一种简单有效的治疗方法。

Objective To evaluate effect of preoperative oral carbohydrate and infusion of glucose on insulin resistance in patients after scar ectomy. Methods A total of 60 cases of elective scar ectomy were divided randomly into three groups： control group, with overnight fasting; oral group, receiving preparation with 12.5% carbohydrate drink （CHO） before operation; and infusion group, continuously infused with 10% glucose fluid before operation. The concentration of blood glucose and plasma insulin and insulin receptor in erythrocytes were detected before preoperative carbohydrate supplementation and at 6 h after operation. Results Among three groups, the concentration of blood glucose and plasma insulin, the level of insulin sensitivity index and the number of insulin receptor in erythrocytes were of no difference. Blood glucose in oral group and infusion group at 6 h after operation was obviously lower than that of control group, but showed no significant difference with that before preoperative carbohydrate supplementation. The concentration of plasma insulin at 6 h after operation among three groups were of no significant difference, but markedly higher than that before preoperative carbohydrate supplementation. After scar ectomy, the level of insulin sensitivity index and the number of low affinity of erythrocyte insulin receptor in oral group and infusion group were markedly elevated as compared with control group although they were all reduced. And in oral group and infusion group, the number of high affinity of erthrocyte insulin receptor was of no difference with that before preoperative carbohydrate supplementation. The concentration of blood glucose and plasma insulin, the level of insulin sensitivity index and the number of insulin receptor in erythrocytes were no significant difference between oral group and infusion group. Conclusion Preoperative glucose infusion could relieve postoperative insulin resistance. Preoperative oral carbohydrate is simple and helpful to reduce postoperative insulin resistance.