混合糖对老年腹部手术后患者糖代谢、胰岛功能和临床结局的影响

Effects of carbohydrate-electrolyte solution on serum glucose, pancreas islet function, and safety in elderly patients after abdominal operation

目的评价混合糖对腹部手术后老年患者血糖、胰岛功能以及安全性的影响。方法采用前瞻、随机、双盲、对照的研究方法。满足方案入选标准并获得知情同意的腹部手术后老年患者共40例进入本研究。研究组于术后第1天或第2天开始连续静脉输注混合糖电解质注射液1000ml，对照组静脉输注10％葡萄糖电解质注射液1000ml，连续3d。观察血糖和胰岛素、胰岛素C肽的变化，同时观察临床结局指标和血尿酸、乳酸等的变化以及不良事件。结果按计划完成本研究40例，无淘汰病例；腹部手术后老年患者输注混合糖后第2和3天血糖升高幅度明显少于对照组（P=0．008，P=0．001）；血胰岛素和胰岛素C肽水平两组较术前均有升高趋势，但组间比较差异无统计学意义；研究组的变化值分别为（11．4±7．8）μU／ml和（639±506）pmol／L，对照组的变化值分别为（13．9±13．0）μU／ml和（1062±905）pmol／L，两组比较差异无统计学意义（P=0．612，P=0．213）。研究组术后发生全身性炎症反应综合征（6例）和感染并发症（4例）的病例数与对照组（8和6例）比较差异无统计学意义（P=0．639，P=0．606）；用药后两组患者均未发现血乳酸和尿酸升高，未出现不良事件。结论适量应用混合糖对腹部手术后患者血糖和胰岛功能的影响较小，可能改善临床结局。

Objective To evaluate the effects of carbohydrate-electrolyte solution （CES） on serum glucose, pancreas islet function, and safety in elderly patients after abdominal operation. Methods In this prospective, double-blinded, randomized, and controlled study, 40 elderly patients who met the defined criteria were enrolled. Subjects in CES group were intravenously administered with 1 000 ml CES for consecutive three days beginning from the 1^st and 2^nd post-operative day, while subjects in the control group were administered with 10% glucose of the same volume under the same arrangement. The changes of serum glucose, insulin and insulin C-peptide, as well as lactic acid and uric acid were determined before and after injection. Adverse events were recorded. Results All patients completed the study. The increase rate of serum glucose was significantly lower on the 2^nd and 3^rd day after injection in CES group than in control group （ P = 0. 008, P = 0. 001 ）. Blood insulin and insulin C-peptide levels showed increasing trends in both two groups, but were not significantly different between two groups （P=0. 612, P =0. 213）. In the CES group, 6 patients experienced systemic inflammatory response syndrome and 4 patients had infective complications after surgeries ; on the contrary, these two numerals were 8 and 6 in the control group （P = 0. 639, P = 0. 606）. No increase in serum lactic acid or uric acid was detected. Conclusion Appropriate application of CES has minimal effect on the blood gluocse and pancreas islet function in elderly patients after abdominal surgery and may be helpful to improve clinical outcomes.