术前口服高糖溶液对胃癌手术患者术后恢复、HOMA-IR及血清hsCRP水平的影响

Effect of preoperative oral high glucose solution on postoperative recovery,HOMA-IR and serum hsCRP level of patients with gastric cancer

目的探讨术前口服高糖溶液对胃癌手术患者术后恢复、胰岛素抵抗指数(homeostasis model assessment-insulinresistance,HOMA-IR)及血清高敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)水平的影响。方法选取2018年1月至2020年6月安徽医科大学附属合肥医院诊治的胃癌患者83例,根据随机数字表法将患者随机分为研究组(42例)和对照组(41例),研究组术前4 h前口服10%葡萄糖溶液(glucose solution,GS)500 ml,对照组术前不服用。观察并比较两组术后恢复(术后首次排气时间、首次排便时间、术后住院时间)、术后并发症发生率、HOMA-IR及血清hsCRP水平。结果两组在性别、年龄、BMI、TNM分期、手术方式等方面差异无统计学意义(P>0.05)。HOMA-IR指数比较,治疗前,两组HOMA-IR指数差异无统计学意义(P>0.05);治疗后,两组HOMA-IR指数均提高[研究组前后(1.80±0.45)vs(5.65±1.46),对照组前后(1.92±0.43)vs(11.70±3.05)],且对照组HOMA-IR指数高于研究组(P<0.05)。hsCRP水平比较,治疗前,两组hsCRP水平差异无统计学意义(P>0.05);治疗后,两组hsCRP水平均提高[研究组前后(1.23±0.90)vs(40.40±27.05),对照组前后(1.40±1.15)vs(80.05±38.85)],且对照组hsCRP水平高于研究组(P<0.05)。术后恢复情况比较,研究组首次排气时间、首次排便时间、术后住院时间均显著低于对照组[(3.35±0.50)、(4.05±0.50)、(14.65±1.90)d vs(4.30±0.90)、(5.70±1.15)、(16.15±2.05)d,P<0.05]。术后并发症情况比较,研究组术后胃出血、吻合口瘘、肠梗阻等并发症总发生率为11.9%,对照组并发症总发生率为14.63%,差异无统计学意义(P>0.05)。结论术前口服高糖溶液能减轻胃癌患者术后胰岛素抵抗、炎症反应,对促进患者术后康复具有积极意义。

Objective To investigate the effects of preoperative oral high glucose solution on postoperative recovery,homeostasis model assessment-insulinresistance and high sensitivity C-reactive protein level in patients with gastric cancer.Methods A total of 83 patients with gastric cancer diagnosed and treated in Hefei Hospital of Anhui Medical University from Jan.2018 to Jun.2020 were selected and divided into study group(42 cases)and control group(41 cases)according to whether or not they were given oral glucose solution before operation.In the first 4 hours,500 ml of 10%glucose solution(glucose solution,GS)was taken orally,and the control group did not take it before surgery.The postoperative recovery(time of first exhaust after operation,time of first defecation,length of hospitalization after operation),postoperative complications,HOMA-IR and serum hsCRP levels between the two groups were observed and compared.Results The two groups had very small differences in general information such as gender,age,BMI,TNM staging,and surgical methods(P>0.05).In comparison of HOMA-IR index,before treatment,the difference of HOMA-IR index between the two groups was small(P>0.05);after treatment,the difference of HOMA-IR index between the two groups increased(1.80±0.45 vs 5.65±1.46 for the study group before and after treatment,1.92±0.43 vs 11.70±3.05 for the control group before and after treatment),and the HOMA-IR index of the control group was higher than that of the study group(P<0.05).In comparison of hsCRP levels,before treatment,there was little difference in hsCRP levels between the two groups(P>0.05);after treatment,hsCRP levels in the two groups increased(1.23±0.90 vs 40.40±27.05 for the study group before and after treatment,and 1.40±1.15 vs 80.05±38.85 for the control group before and after treatment),and the hsCRP level of the control group was higher than that of the study group(P<0.05).In terms of postoperative recovery,the study group’s first exhaust time,first defecation time,and postoperative hospital stay were significantly shorter than those of the control group[(3.35±0.50,4.05±0.50,14.65±1.90)vs(4.30±0.90,5.70±1.15,16.15±2.05),P<0.05].In comparison with postoperative complications,the total incidence of postoperative gastric bleeding,anastomotic leakage,intestinal obstruction,and other complications was 11.9%for the study group and the total incidence of complications was 14.63%in the control group(P>0.05).Conclusions After operation,oral GS can reduce insulin resistance and inflammation in patients with gastric cancer.It has positive significance to promote postoperative rehabilitation.