| PURPOSE In recent years,the value of preoperative glucose load intervention in the perioperative period of body function and metabolic changes in patients with malignant tumors has been reported by more and more researchers.This study explored the effects of preoperative oral carbohydrate(CHO)on perioperative insulin resistance,subjective comfort,intraoperative blood glucose changes,and short-term recovery after esophageal cancer(EC).The elective surgery for EC patients provides improved theoretical preoperative fasting and no-drinking strategies to provide a theoretical basis.METHODS Prospective analysis of 118 patients with EC who underwent elective surgery in cardiothoracic surgery in the Jinling Hospital from January 2018 to February 2019.The enrollment method randomly divided the patients into two groups.The experimental group(oral CHO group): fasted after dinner 1 day before surgery,oral CHO of 12.6% sugar solution 800 ml,400ml,10 hours and 2 hours before surgery respectively;control group: the same fasting as CHO group,10 h,2h before surgery sterilized water for injection 800 ml,400 ml.The clinical characteristics and surgical data of the patients were collected.The blood glucose and serum insulin indexes of the patients were admitted to the hospital on the 1st,3rd,and 7th postoperative day.The visual analog scale(VAS)was used to measure the patient's 6 dimensions subjective comforts.Blood glucose level at the observation point;observe the postoperative recovery of the patient(such as the first anal exhaust time,bedtime,chest drainage tube indwelling time,total thoracic drainage,postoperative hospital stay(LOS))and postoperative complications,etc.The observations were statistically analyzed using SPSS 22.0 statistical software.The differences in insulin resistance,subjective comfort,intraoperative blood glucose changes,short-term recovery after surgery,and complications were compared between the two groups.Preoperative oral carbohydrates were judged based on the results.Whether there is a positive effect on the perioperative period of patients with esophageal cancer.RESULTS Finally,statistical analysis was performed on 47 patients in the experimental group and 48 patients in the control group.There was no statistical difference in clinical baseline data between the subjects.The preoperative oral CHO patients were superior to the control group in terms of blood glucose,serum insulin and insulin resistance on the 1st and 3rd day after operation(p<0.05,p <0.05,p <0.01),and could be reduced to the normal range quickly.The hunger was measured 1 hour before surgery by VAS([2(1,3)] vs [3(2,4)],p=0.005),and thirst([1(1,2)] vs [ 3(1,4)],p <0.001),fatigue([1(0,1)] vs [1(0,1.75)],p=0.041)was stronger than the test group.The VAS score,blood glucose of the test patients was no significant difference in baseline data.The fluctuation of blood glucose in the experimental group was stable compared with the control group(p <0.05),and the first anal exhaust time in the oral CHO group was earlier than that in the control group(2.5±0.4 vs 2.7±0.5 d,p=0.034).The difference in postoperative LOS and complications was not statistically significant.CONCLUSION Preoperative oral CHO can reduce postoperative insulin resistance in EC patients,reduce perioperative blood glucose fluctuations,and stabilize the body's related metabolic changes;it can improve the subjective comfort of patients with elective esophageal cancer before surgery on hunger,thirst and fatigue;CHO accelerates the recovery of patients to some extent,but there is no significant improvement in the postoperative complications of EC patients. |
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