缩短术前禁食禁水时间对肝癌合并糖尿病患者术后康复情况的影响

摘要

目的 探讨缩短术前禁食禁水时间对肝癌合并糖尿病患者术后康复情况的影响.方法 选取海南省人民医院2013年4月至2015年4月收治的肝癌合并糖尿病患者140例,按入院先后顺序分为对照组和观察组,各70例.对照组患者在手术前1d晚20:00后禁食,24:00后禁水.观察组患者在手术前1d晚24:00前根据需要适当的进食总量＜400 ml的半流质清淡饮食,且在术前2～3h口服200 ml 5％葡萄糖注射液.比较2组患者术前口渴、饥饿、焦虑、腹部不适发生情况,手术前后空腹血糖、空腹胰岛素、血清C肽水平以及稳态模型评估法胰岛素抵抗指数(HOMA-IR),手术前后肝功能指标以及住院时间和并发症发生情况.结果 观察组术前口渴、饥饿患者比例明显低于对照组,差异均有统计学意义[54.3％(38/70)比81.4％(57/70)、54.3％(38/70)比84.3％(59/70)](均P＜0.05).2组焦虑、腹部不适患者比例比较,差异无统计学意义(P＞0.05).术前,2组空腹血糖、空腹胰岛素、血清C肽、HOMA-IR差异均无统计学意义(P＞0.05).术后,观察组血清C肽水平高于对照组,HOMA-IR低于术前和对照组,差异均有统计学意义[(1.4±0.7) μg/L比(0.9±0.4)μg/L,(1.05 ±0.69)比(1.77±0.69)、(1.89±0.26)](均P＜0.05),但2组空腹血糖、空腹胰岛素水平差异无统计学意义(P＞0.05).术后,2组肝功能指标、住院时间以及并发症发生率差异均无统计学意义(均P＞0.05).结论 适当缩短术前禁食禁水时间可以有效改善肝癌合并糖尿病患者术前饥饿感和口渴感以及术后胰岛素的抵抗能力.%Objective To analyze the influence of shortening time of preoperative fasting for solids and liquids on postoperative rehabilitation in patients with hepatic carcinoma complicated with diabetes mellitus.Methods Totally 140 patients with hepatic carcinoma complicated with diabetes were enrolled and divided into control group and observation group in order (each 70 cases).Patients in control group fasted for solids from 20:00 and fasted for liqids from 24:00 1 d before operation;patients in observation group received semiliquid light diet (＜400 ml) before 24:00 1 d before operation,and orally given 5％ glucose solution 200 ml 2-3 h before operation.The incidence of preoperative thirst,hunger,anxiety,abdominal discomfort,the preoperative and postoperative fasting blood glucose,fasting insulin,serum C peptide and insulin resistance index (HOMA-IR),the postoperative complications,liver function index and hospitalization duration time were compared between groups.Results The proportions of preoperative thirst and hunger in observation group were significantly lower than those in control group [54.3％ (38/70) vs 81.4％ (57/70),54.3％ (38/70) vs 84.3％ (59/70)] (P ＜ 0.05).There was no significant difference in proportions of anxiety and abdominal discomfort between groups (P ＞ 0.05).Before operation,there were no significant differences in fasting blood glucose,fasting insulin,serum C peptide and HOMA-IR between groups (P ＞ 0.05).After operation,the serum C peptide level was significantly higher than that in control group,the HOMA-IR was significantly lower than that before operation and that in control group [(1.4±0.7) μg/Lvs (0.9±0.4) μg/L,(1.05 ±0.69) vs (1.77±0.69),(1.89±0.26)] (P＜0.05),while the fasting blood glucose and insulin level were not significantly different between groups (P ＞ 0.05).After surgery,the incidence of complications,liver function indexes and hospitalization during time were not significantly different between groups (P ＞ 0.05).Conclusion Appropriately shortening preoperative fasting time for solids and liqids can effectively improve the preoperative hunger and thirst,and improve the postoperative insulin resistance in liver cancer patients complicated with diabetes,.