术前口服碳水化合物溶液研究进展

Preoperative oral carbohydrates at a glance

传统术前禁饮、禁食的概念可能导致患者术前饥饿、口渴、焦虑等主观不适,引起术中血压波动和术后胰岛素抵抗,增加围手术期相关并发症的发生。近年来,研究表明,术前2~3 h口服碳水化合物溶液(preoperative carbohydrates,POC)在不增加反流误吸和手术风险的基础上有效改善上述不良反应,但目前尚无明确使用指南。文章拟讨论POC的发展史,临床应用现状及有效性,并重点围绕POC促进择期手术患者机体合成代谢、缓解负氮平衡,改善术后胰岛素抵抗,减少患者主观不适感等临床效益及相关潜在机制,以及特殊患者应用POC的安全性等展开论述,强调POC对手术患者的积极作用,以期为临床工作中POC的合理应用及推广提供理论支撑。

Preoperative fasting may results in discomfort feelings,such as hunger,thirst and anxiety of patients,or cause severely blood pressure variation and postoperative insulin resistance,which may increase the ratio of complication happening.Based on latest researches,preoperative oral carbohydrate solution(POC),can ameliorate complications mentioned above without increasing any risk of surgeries or anesthesia.However,there is no definite guidance for standardizing the clinical use.This review aims to discuss the development of POC and current clinical application,focusing on not only the benefits and mechanism of POC,such as alleviating patients'negative nitrogen balance,remitting postoperative insulin resistance and improving patients'subjective feelings,but also the safety.We hope this review provides theoretical basis for the wide POC using in clinical practice.