术前口服10%葡萄糖溶液对胃癌患者围手术期胰岛素抵抗的影响

The effect of the preoperative oral intake of 10% glucose solution on postoperative insulin resistance in patients undergoing gastric cancer resection

目的:探讨术前口服10%葡萄糖溶液对胃癌手术患者的安全性及对术后胰岛素抵抗的影响。方法:选取2012年3-12月间拟行胃癌根治术的患者36例,随机分为糖水组、蒸馏水组和禁饮组。糖水组术前2 h口服10%葡萄糖溶液500 mL,蒸馏水组口服同等量蒸馏水,禁饮组则术前常规禁食禁水。用视觉模拟评分法(VAS)测定三组患者的主观舒适度,根据患者外周血葡萄糖和胰岛素浓度,用稳态模式评估法(HOMA)计算胰岛素抵抗(IR)指数和胰岛素敏感指数,同时观察患者胃内残留量、术后肛门首次排气排便时间。结果:术前2 h口服10%葡萄糖溶液未显著增加术前胃内残留量(P>0.05),可明显减轻患者的口渴感和饥饿感(P<0.01)。三组患者在术后首次排气排便时间上无明显差异(P>0.05)。术毕、术后第1、3天糖水组的IR程度均明显低于其他两组(P<0.05),而ISI则显著高于其他两组(P<0.01)。结论:胃癌患者术前2 h口服500 mL 10%葡萄糖溶液是安全的,并可缓解术前的口渴感和饥饿感,减轻术后胰岛素抵抗。

Objective To investigate the effect of oral intake of 10% glucose solution before surgery on the perioperative safety and postoperative insulin resistance in patients undergoing resection for gastric cancer. Methods Between March 2012 and December 2012,36 patients undergoing elective resection for gastric cancer were enrolled and randomized into three groups. Patients in group A were given 500ml of 10% glucose solution for oral intake two hours before surgery. Patients in the group B were given distilled water instead of glucose. Patients in the group C were asked to fast for 8 hours before operation. Patient′s wellbeing scores on a visual analogue scales（VAS） were recorded. Blood samples were collected to measure. Homeostasis model assessment（HOMA） was applied to assess the status of insulin resistance（HOMA-IR） and insulin sensitivity index（ISI） according to the level of blood glucose and the serum concentration of insulin. The gastric residues before anesthesia and the time of exhaustion and defecation were also recorded. Results The gastric residues were not increased significantly after the intake of 10% glucose solution（P 〉 0.05）. Intake of 10% glucose solution before surgery relieved thirst and hunger（P〈0.01）. The time of exhaustion and defecation in three groups was not significantly different（P 〉 0.05）. The HOMA-IR levels postoperative immediately, on the first day and the third day after surgery were lower in group A than that of group B and group C（P〈0.05）, but the ISI levels were higher significantly（P〈0.01）. Conclusion Intake of 10% glucose solution 2 hours before surgery for gastric cancer is be safe, which can relieve preoperative thirst and hunger, and improve postoperative insulin resistance.