术前口服葡萄糖溶液对结直肠肿瘤术后肠黏膜屏障功能的保护作用

Effects of preoperative oral glucose on postoperative intestinal barrier function after colorectal surgery

目的探讨术前口服葡萄糖溶液对结、直肠肿瘤术后肠道屏障功能及肠道功能恢复的影响。方法将择期行结直肠肿瘤根治手术的40例患者按随机数据表法随机分为糖水组及禁食组。糖水组19例,于术前晚7～12时口服质量分数为12.5%的葡萄糖溶液800ml,麻醉诱导前2小时再口服12.5%的葡萄糖溶液200ml;禁食组18例,术前常规禁食8～12h。手术采用气管插管静吸复合全麻加硬膜外麻醉维持,监测术前1天及术后第1、3、7天血浆内毒素浓度及血浆胰岛素样生长因子Ⅰ(IGF-I)浓度;比较两组术后开始排气及排便时间。结果术后第1、3天糖水组血浆内毒素浓度(pg/ml)均低于禁食组(2.43±0.09vs2.83±0.56;2.55±0.39vs2.94±0.55,P<0.05);糖水组IGF-Ⅰ水平(μg/L)于术后第1天高于禁食组(90.65±55.06vs55.72±26.39,P<0.05),差异均有统计学意义;糖水组排气、排便时间(h)均早于禁食组,分别为(59.82±13.88vs73.70±11.47)、(65.36±18.48vs86.64±10.12),P均<0.05。结论术前口服葡萄糖溶液可保护结、直肠肿瘤切除术后的肠黏膜屏障功能,并促进患者早期排气排便,值得在临床推广。

Objective To investigate the effect of preoperative oral glucose on the intesternal barrier function and the recovery of bowel function after colorectal cancer resection. Methods Between January 2010 and December 2010, 40 patients undergoing radical resection for colorectal cancer were enrolled and randomized into two groups using the table of random digits. Three patients were withdrawn from the study because infusing blood. Patients in group A （ 19 cases） orally took 12.5% glucose solution 800 ml the night 7-12 pm before surgery and 12.5% glucose solution 200 ml 2 hours before surgery. Patients in group B （18 cases） were fasted over night before surgery. Anesthesia was maintained by combined general and epidural anesthesia. Plasma endotoxin and Insulin-like growth factor I （IGF- I ） were detected preoperatively and on POD-I,3,7. Time of first flatus and first bowel movement was recorded. Results The level of plasma endotoxin （pg/ml） in group A at POD-1 and POD-3 were significantly lower than that in group B （2.43 ± 0.09 vs 2.83± 0.56, 2.55 ± 0.39 vs 2.94±0.55, P 〈 0.05）. The levels of IGF- I concentration （μg/L） in POD-1 in group B was lower than that in group A （55.72 ± 26.39 vs 90.65 ± 55.06, P 〈 0.05）. The time of first passage of flatus and first bowel movement in the group A were （59.82 ±13.88） h and （65.36 ± 18.48） h, which were significantly shorter than that in group B （73.70± 11.47） h and （86.64 ± 10.12）h, P 〈 0.05. Conclusion Preoperative oral carbohydrate can reduce the damage on intestinal mucosal barrier of colorectal cancer resection, promote bowel movements and enhance the recovery of bowel function.