中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
20期
8-10
,共3页
马顺茂%刘红磊%任瑞锋%陈咏梅%孟繁杰
馬順茂%劉紅磊%任瑞鋒%陳詠梅%孟繁傑
마순무%류홍뢰%임서봉%진영매%맹번걸
胃肠道间质肿瘤%胰岛素抗药性%糖预处理
胃腸道間質腫瘤%胰島素抗藥性%糖預處理
위장도간질종류%이도소항약성%당예처리
Gastroentestinal stromal tumors%Insulin resistance%Preoperative carbohydrate administration
目的 探讨糖预处理对胃肠道肿瘤手术后胰岛素抵抗的影响.方法 选取60例择期行胃肠道肿瘤手术患者,按随机数字表法分为观察组和对照组,每组30例.观察组术前给予糖预处理,即麻醉前2h口服含50 g葡萄糖的碳水化合物300 ml;对照组患者按传统方法进行处理,术前12h禁食,术前6h禁饮.于术前3h和术后1,3,7d分别抽取患者外周血,监测空腹血糖(FBG)、空腹胰岛素(FINS)水平,采用稳态模型法计算胰岛素抵抗指数(HOMA-IR).结果 术后1,3d两组FBG、FINS水平及HOMA-IR均明显高于术前3h[观察组:(10.65±1.78)、(7.32±1.48) mmol/L比(5.09±0.43) mmol/L,(25.78±12.43)、(16.23±7.56) mU/L比(10.48±1.57) mU/L,11.67±6.32、5.12±2.11比2.35±0.54;对照组:(11.18±1.25)、(8.04±1.53) mmol/L比(5.12±0.39) mmol/L,(39.67±10.37)、(24.34±6.78) mU/L比(9.98±2.04) mU/L,19.07±5.49、8.56±2.87比2.28±0.39],差异有统计学意义(P＜ 0.05);术后1d对照组FINS及HOMA-IR明显高于观察组,术后3d对照组FINS及HOMA-IR明显高于观察组,差异有统计学意义(P＜0.05);术后7d观察组FINS及HOMA-IR接近术前3h,差异无统计学意义(P＞ 0.05),而对照组[(16.32±4.56) mU/L、3.87±1.12]仍高于术前3h,差异有统计学意义(P＜0.05).结论 糖预处理可以缩短胃肠道肿瘤手术后胰岛素抵抗的时间,减轻胰岛素抵抗的强度,从而有利于患者的加速康复.
目的 探討糖預處理對胃腸道腫瘤手術後胰島素牴抗的影響.方法 選取60例擇期行胃腸道腫瘤手術患者,按隨機數字錶法分為觀察組和對照組,每組30例.觀察組術前給予糖預處理,即痳醉前2h口服含50 g葡萄糖的碳水化閤物300 ml;對照組患者按傳統方法進行處理,術前12h禁食,術前6h禁飲.于術前3h和術後1,3,7d分彆抽取患者外週血,鑑測空腹血糖(FBG)、空腹胰島素(FINS)水平,採用穩態模型法計算胰島素牴抗指數(HOMA-IR).結果 術後1,3d兩組FBG、FINS水平及HOMA-IR均明顯高于術前3h[觀察組:(10.65±1.78)、(7.32±1.48) mmol/L比(5.09±0.43) mmol/L,(25.78±12.43)、(16.23±7.56) mU/L比(10.48±1.57) mU/L,11.67±6.32、5.12±2.11比2.35±0.54;對照組:(11.18±1.25)、(8.04±1.53) mmol/L比(5.12±0.39) mmol/L,(39.67±10.37)、(24.34±6.78) mU/L比(9.98±2.04) mU/L,19.07±5.49、8.56±2.87比2.28±0.39],差異有統計學意義(P＜ 0.05);術後1d對照組FINS及HOMA-IR明顯高于觀察組,術後3d對照組FINS及HOMA-IR明顯高于觀察組,差異有統計學意義(P＜0.05);術後7d觀察組FINS及HOMA-IR接近術前3h,差異無統計學意義(P＞ 0.05),而對照組[(16.32±4.56) mU/L、3.87±1.12]仍高于術前3h,差異有統計學意義(P＜0.05).結論 糖預處理可以縮短胃腸道腫瘤手術後胰島素牴抗的時間,減輕胰島素牴抗的彊度,從而有利于患者的加速康複.
목적 탐토당예처리대위장도종류수술후이도소저항적영향.방법 선취60례택기행위장도종류수술환자,안수궤수자표법분위관찰조화대조조,매조30례.관찰조술전급여당예처리,즉마취전2h구복함50 g포도당적탄수화합물300 ml;대조조환자안전통방법진행처리,술전12h금식,술전6h금음.우술전3h화술후1,3,7d분별추취환자외주혈,감측공복혈당(FBG)、공복이도소(FINS)수평,채용은태모형법계산이도소저항지수(HOMA-IR).결과 술후1,3d량조FBG、FINS수평급HOMA-IR균명현고우술전3h[관찰조:(10.65±1.78)、(7.32±1.48) mmol/L비(5.09±0.43) mmol/L,(25.78±12.43)、(16.23±7.56) mU/L비(10.48±1.57) mU/L,11.67±6.32、5.12±2.11비2.35±0.54;대조조:(11.18±1.25)、(8.04±1.53) mmol/L비(5.12±0.39) mmol/L,(39.67±10.37)、(24.34±6.78) mU/L비(9.98±2.04) mU/L,19.07±5.49、8.56±2.87비2.28±0.39],차이유통계학의의(P＜ 0.05);술후1d대조조FINS급HOMA-IR명현고우관찰조,술후3d대조조FINS급HOMA-IR명현고우관찰조,차이유통계학의의(P＜0.05);술후7d관찰조FINS급HOMA-IR접근술전3h,차이무통계학의의(P＞ 0.05),이대조조[(16.32±4.56) mU/L、3.87±1.12]잉고우술전3h,차이유통계학의의(P＜0.05).결론 당예처리가이축단위장도종류수술후이도소저항적시간,감경이도소저항적강도,종이유리우환자적가속강복.
Objective To explore the effect of carbohydrate administration on postoperative insulin resistance after gastroenteric tumor resection.Methods Sixty elective gastroenteric tumor resection patients were divided into observation group and control group by random number table method,with 30 cases in each.Observation group was given carbohydrate administration before surgery,that was 2 h before anesthesia oral carbohydrates 300 ml containing 50 g glucose;control group was treated according to the traditional methods,preoperative fasting 12 h,6 h forbidden to drink.The blood samples were collected to measure the levels of fasting blood glucose (FBG) and fasting insulin (FINS) at 3 h before operation and 1,3,7 d postoperation respectively.Homeostasis model assessment (HOMA) was applied to calculate the insulin resistance index.Results The levels of FBG,FINS,HOMA-IR at 1,3 d postoperation in two groups were significantly higher than those at 3 h preoperation [observation group:(10.65 ± 1.78),(7.32 ± 1.48) mmol/L vs.(5.09 ±0.43) mmol/L,(25.78 ± 12.43),(16.23 ±7.56) mU/L vs.(10.48 ± 1.57) mU/L,11.67 ±6.32,5.12 ± 2.11 vs.2.35 ± 0.54;control group:(11.18 ± 1.25),(8.04 ± 1.53) mmol/L vs.(5.12 ± 0.39) mmol/L,(39.67 ± 10.37),(24.34 ± 6.78) mU/L vs.(9.98 ± 2.04) mU/L,19.07 ± 5.49,8.56 ± 2.87 vs.2.28 ± 0.39](P ＜ 0.05).The levels of FINS,HOMA-IR at 1,3 d postoperation in control group were higher than those in observation group (P ＜ 0.05).The levels of FINS and HOMA-IR at 7 d postoperation in observation group were returned to the 3 h preoperative (P ＞ 0.05),while the levels in control group [(16.32 ± 4.56) mU/L,3.87 ± 1.12] was still higher than those at 3 h preoperation (P ＜0.05).Conclusion Carbohydrate administration may shorten the insulin resistance durion after gastroenteric tumor resection,and reduce the intensity of insulin resistance,thus contributing to the rehabilitation of patients.
