术前口服葡萄糖溶液对胃癌患者围术期稳态模型评估-胰岛素抵抗指数和血浆内毒素水平的影响

Effect of preoperative oral glucose solution on homeostasis model assessment-insulin resistance index and plasma endotoxin level in patients with gastric cancer

目的分析术前口服葡萄糖溶液对胃癌患者围术期稳态模型评估-胰岛素抵抗(homeostasis model assessment-insulin resistance,HOMA-IR)指数和血浆内毒素水平的影响。方法将首都医科大学附属北京朝阳医院2017年1月至2019年1月收治的70例胃癌患者随机分为葡萄糖组和对照组,每组各35例,两组患者均行外科手术治疗,葡萄糖组患者术前1 d 22:00和手术当日清晨6:00口服5%葡萄糖溶液500 ml,对照组患者术前常规禁食禁饮。记录两组患者手术情况、HOMA-IR指数、稳态模型评估-胰岛β细胞功能(homeostasis model assessment-isletβcell function index,HOMA-β)指数、肠黏膜屏障功能变化,分析胃癌患者术前口服葡萄糖溶液的临床价值。结果两组患者手术时间、术中出血量、胃内残留量、校正胃内残留量比较差异均无统计学意义(均P>0.05),葡萄糖组患者首次排气时间、首次排便时间均显著短于对照组(均P<0.05)。葡萄糖组患者围术期HOMA-β指数、HOMA-IR指数、血浆内毒素水平均未见显著显变化(均P>0.05)。术后1 d、术后3 d,对照组患者HOMA-IR指数均显著大于本组术前3 h(均P<0.05),且均显著大于同期葡萄糖组(均P<0.05);血浆内毒素水平均显著高于本组术前3 h(均P<0.05),且均显著高于同期葡萄糖组(均P<0.05);HOMA-β指数均显著小于本组术前3 h(均P<0.05),且均显著小于同期葡萄糖组(均P<0.05)。术后1 d和术后3 d,对照组患者血浆内毒素水平均显著高于本组术前3 h(均P<0.05),且均显著高于同期葡萄糖组(均P<0.05)。结论术前口服葡萄糖溶液能够减轻胃癌患者术后胰岛素抵抗、保护肠黏膜功能,对于促进患者术后康复具有积极意义。

Objective To analyze the effect of preoperative oral glucose solution on perioperative insulin resistance(HOMAIR)index and plasma endotoxin level in patients with gastric cancer.Method 70 patients with gastric cancer in Beijing Chaoyang Hospital,Capital Medical University from January 2017 to January 2019 were randomly divided into glucose group and control group,35 cases in each group.All patients in the two groups underwent surgical treatment.Glucose group patients were given 500 ml of 5%glucose solution 1 day before operation at 10:00 p.m.and the day of operation at 6:00 a.m.Control group patients were given normal fasting water before operation.The operation status,HOMA-IR,HOMA-βand intestinal mucosal barrier function were recorded in the two groups,and the clinical value of oral glucose solution before gastric cancer operation was analyzed.Result There were no significant differences in operation time,intraoperative bleeding volume,intragastric residue and corrected intragastric residue between the two groups(all P>0.05),the first exhaust time and first defecation time in the glucose group were significantly shorter than those in control group(all P<0.05).There were no significant changes in HOMA-βindex,HOMA-IR index and plasma endotoxin level in glucose group during the perioperative period(all P>0.05).The HOMA-IR index of control group patients on 1 day and 3 days after operation were significantly larger than that of 3 hours before operation(all P<0.05),and were significantly larger than that of glucose group at the same time(all P<0.05);the plasma endotoxin level was significantly higher than that of 3 hours before operation(all P<0.05),and were significantly higher than that of glucose group at the same time(all P<0.05);the HOMA-βindex was significantly lower than that of 3 hours before operation(all P<0.05),and were significantly smaller than that of glucose group at the same time(all P<0.05).1 day and 3 days after operation,the plasma endotoxin levels in control group were significantly higher than that of 3 hours before operation(all P<0.05),and were significantly higher than that of glucose group at the same time(all P<0.05).Conclusion Oral glucose solution before operation can alleviate insulin resistance and protect intestinal mucosal function in patients with gastric cancer after operation.It has positive significance for promoting postoperative rehabilitation.