术前糖预处理对择期结直肠手术后胰岛素抵抗作用的Meta分析

J4 ›› 2012, Vol. 38 ›› Issue (6): 1173-1179.

术前糖预处理对择期结直肠手术后胰岛素抵抗作用的Meta分析

应项吉^1,2|李伦^1,3|孙甜甜⁴|田宏亮^1,3|孙绕¹|杨克虎^1,3|田金徽^1 |

1.兰州大学基础医学院循证医学中心|甘肃兰州 730000；2.兰州大学第二临床医学院|甘肃兰州 730000；3.兰州大学第一临床医学院|甘肃兰州 730000；4.上海交通大学仁济医院|上海 200001

收稿日期:2012-04-15 发布日期:2012-11-28
通讯作者: 田金徽（Tel: 0931-8915076,E-mail：tjh996@163.com） E-mail:tjh996@163.com
作者简介:应项吉（1990-）|女|浙江省金华市人|医学本科|主要从事循证医学和循证营养学研究。
基金资助:
兰州大学博士生学术新人项目资助课题;2012年兰州大学创新创业项
目资助课题

Meta-analysis on effect of preoperative carbohydrate administration
 on |insulin resistance after colorectal surgery


YING Xiang-ji^1,2,LI Lun^1,3,SUN Tian-tian^4,TIAN Hong-liang ^1,3,SUN Rao¹,YANG Ke-hu^1,2,TIAN Jin-hui ¹

1. Evidence Based Medicine Center,School of Basic Medical Sciences,Lanzhou University,Lanzhou 730000,China;2. Second Clinical Medical College,Lanzhou University,Lanzhou 730000,China;3. First Clinical Medical College,Lanzhou University,Lanzhou 730000,China;4.Renji Hospital, Shanghai Jiaotong University,Shanghai 200001,China

Received:2012-04-15 Published:2012-11-28

摘要/Abstract

摘要：

目的: 评价术前糖预处理结直肠手术后预防胰岛素抵抗的有效性和安全性，为临床实践提供参考。方法: 按照系统评价的要求计算机检索中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库、中国医学会数字化期刊库、PubMed、Cochrane Library、EMbase、ISI Web of Knowledge，同时手工检索相关期刊，纳入术前糖预处理结直肠手术后预防胰岛素抵抗的随机对照试验，依据Cochrane 评价手册5.0标准对纳入文献的方法学质量进行评估,采用RevMan 5.0软件对符合纳入标准的7个随机对照试验进行Meta分析。结果：共纳入7个随机对照研究，共728例患者。在术前口服碳水化合物组较术前常规禁食水组胰岛素敏感指数(ISI)升高(SMD=－0.38,95%CI=－0.65～0.11，I2 = 94%)和胰岛素抵抗指数（IRI）降低(SMD=－1.82,95%CI=－2.67 ~－0.98)方面存在差异，但可降低术前患者饥饿感、焦虑感和口渴感。术前口服碳水化合物较术前口服安慰剂可降低IRI(SMD=－1.34,95%CI=－2.12 ~－0.57)，增加ISI(SMD=1.06,95%CI= 0.32~1.81)，不能降低术前患者的焦虑感和恶心感。术前口服碳水化合物在术后胰岛素水平(SMD= 3.51,95%CI= 2.99~4.03)和术后第1天胰岛素水平(SMD= 0.65,95%CI= 0.31~0.98)方面较术前静滴葡萄糖增高幅大，且延长患者住院时间(SMD= 0.45,95%CI= 0.12~0.78)。结论：术前口服碳水化合物较术前常规禁食水更可能降低术前患者饥饿感、焦虑感和口渴感；术前口服碳水化合物较术前口服安慰剂更可能降低IRI和ISI；术前静滴葡萄糖较术前口服碳水化合物更可能增高术后胰岛素敏感程度，且降低患者住院时间。

关键词: 术前糖预处理；结直肠手术；质量评价；随机对照试验；Meta分析

Abstract:

Objective To evaluate the effectiveness and safety of preoperative carbohydrate administration on insulin resistance after colorectal surgery,and to provide basis for clinical treatment.MethodsAccording to the criteria of systematic reviews,a thorough literature search related to randomized controlled trials (RCTs) for effectiveness and safety evaluation of preoperative carbohydrate administration on insulin resistance after colorectal surgery was performed among China Journal Full-text Database,Chinese Biomedical Database,Chinese Scientific Journals Full-text Database,CMA Digital Periodicals,PubMed,Cochrane Library,Embase,ISI Web of Knowledge,and the hand search on relevant journals was performed as a supplement.The methodological qualities of the included literatures were assessed by Cochrane Handbook Version 5.0. RevMan 5.0 software was used for Meta-analysis of seven included RCTs.Results Seven RCTs involving 728 participants were included.It was controversial that preoperative oral carbohydrate administration could increase insulin sensitive index (ISI) (SMD=－0.38,95%CI=－0.65—－0.11,I2 = 94%) and decrease insulin resistance index (IRI) (SMD=－1.82,95%CI=－2.67—－0.98) compared with preoperative fasting group;however,preoperative oral carbohydrate administration could decline the preoperative hunger,anxiety and thirst. Compared with preoperative placebo,preoperative oral carbohydrate administration could increase ISI (SMD= 1.06,95%CI= 0.32－1.81) and decreaseIRI (SMD=－1.34,95%CI=－2.12—－0.57).The level of postoperative insulin (SMD= 3.51,95%CI= 2.99－4.03) was increased and the level of insulin in the 1st day after surgery (SMD= 0.65,95%CI= 0.31－0.98) was increased in preoperative oral carbohydrate administration group compared with preoperative intravenous glucose injection group.The hospitalization time of patients in preoperative oral carbohydrate administration group was longer than that in postoperative intravenous glucose injection group (SMD= 0.45,95%CI= 0.12－0.78).Conclusion Preoperative oral carbohydrate administration can reduce preoperative hunger,anxiety and thirst compared with preoperative fasting,and increase ISI and decrease IRI compared with preoperative placebo.Preoperative intravenous glucose injection can increase postoperative ISI and shorten hospitalization time compared with preoperative oral carbohydrate administration.

Key words: preoperative carbohydrate administ
ration, colorectal surgery, quality
evaluation, randomized controlled trials, Meta-analysis

中图分类号:

应项吉|李伦|孙甜甜|田宏亮|孙绕|杨克虎|田金徽. 术前糖预处理对择期结直肠手术后胰岛素抵抗作用的Meta分析[J]. J4, 2012, 38(6): 1173-1179.

YING Xiang-ji,LI Lun,SUN Tian-tian,TIAN Hong-liang,SUN Rao,YANG . Meta-analysis on effect of preoperative carbohydrate administration
 on |insulin resistance after colorectal surgery
[J]. J4, 2012, 38(6): 1173-1179.

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