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

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

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。

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 1^st and 3^rd postoperative day(POD1,POD3)than the control group(P<0.05).(4)The polysaccharide solution group had lower postoperative WBC 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.