Effect of preoperative oral carbohydrate intake on insulin resistance and perioperative safety in elderly patients with diabetes mellitus type 2(T2DM)after joint replacement
Objective To investigate the effect of preoperative oral carbohydrate on insulin resistance and perioperative safety in elderly patients with diabetes mellitus type 2(T2DM)complicated with high infec-tion risk undergoing orthopedic surgery.Methods 90 elderly patients with joint replacement admitted to the hospitalfrom September 2021 to September 2023 were selected as the research subjects.Using a ran-dom number table method,the patients were divided into a control group(NC group),an oral carbohy-drate(OC)group 1 and an OC2 group,with 30 patients in each group.3 groups of the patients took 0,100 and 200 mL of carbohydrate drinks(Suqian)2 hours before the surgery,and the differences in gastric volume related indicators,vital signs indicators,insulin resistance related indicatorsand clinical symptom scores among the 3 groups were compared.Result(1)After 1 hour of the surgery,the mean arterial pressure(MAP)of the patients in the OC2 group was significantly lower than that in the NC group and OC1 group(P＜0.05).At 1 hour of the surgery and when the tracheal duct was removed,the bispectral index of EEG in the OC2 group was significantly higher than that in the NC group and OC1 group(P＜0.05).(2)At 3 time points before anesthesia induction,anesthesia awakening,and the next morning,compared with the NC group and OC1 group,the OC2 group had significantly higher albumin levels(P＜0.05)and significantly lower levels of adrenocorticotropic hormone(ACTH)(P＜0.05).Compared with NC group,the fasting insulin(FINS)and insulin resistance index(HOMA-IR)of the patients in the OC1 and OC2 groups was gradually decreased(P＜0.05).(3)24 hours after the surgery,compared with the NC group,the patients in the OC1 and OC2 groups had significantly lower scores for symptoms such as anxiety,depression,hunger,thirst,pain,nausea and fatigue.The differences between the 2 groups were statistically significant(P＜0.05).(4)Compared with the NC group patients,the incidence of postopera-tive nausea,vomiting,and infection in the OC1 and OC2 groups was lower(P＜0.05),and the first post-operative exhaust time was shorter(P＜0.05).Conclusion Oral administration of 200 mL carbohydrates 2 hours before joint replacement surgery in elderly patients can maintain an appropriate blood glucose con-centration,reduce perioperative insulin resistance,and alleviate postoperative symptoms.
万方数据
维普
