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대장절제술 환자에서 수술 전 경구용 Carbohydrate-Rich 음료 복용과 인슐린 저항성 관계
체리안시오 ( Cherry Ann Sio ),정규환 ( Kyuw Han Jung ),강성범 ( Seong Bum Kang ),김덕우 ( Duk Woo Kim ),오흥권 ( Heung Kwon Oh ),윤미옥 ( Miok Yoon ) 한국정맥경장영양학회 2015 한국정맥경장영양학회지 Vol.7 No.2
Purpose: Reducing preoperative fasting time showed positive effects in several studies, and current guidelines suggest use of a preoperative oral carbohydrate-rich solution before elective surgeries. For elective colectomy procedures, some surgeons favor two-day bowel preparation with diet restriction and administration of laxatives. Aside from patients experiencing the discomfort of nil per os (NPO), there are reported benefits regarding intake of liquids until at least two hours prior to surgery, including decrease in insulin resistance, without additional postoperative surgical complications. The aim of this study is to show the benefits of administration of oral rehydration solution (ORS) two hours prior to surgery for patients undergoing elective colectomy, particularly postoperative insulin resistance. Methods: This is a randomized controlled trial. All patients undergoing elective colectomy were included and randomized to the control arm or treatment arm. The control arm consisted of the standard bowel preparation and one day of NPO, while the treatment arm consisted of the standard bowel preparation and allowing intake of carbohydrate-rich ORS until 2 hours before surgery. The insulin, glucose, cortisol, and triglyceride levels were determined immediately after induction, 6 hours, 24 hours, and 48 hours post-op, and compared. The homeostatic model assessment-insulin resistance, insulin, glucose, cortisol, and triglyceride levels were determined and compared between the two groups. Anxiety and postoperative complications were monitored and assessed as well. Results: There was less insulin resistance in patients who received ORS 2 hours prior to surgery. Insulin, glucose, cortisol, and triglyceride levels were lower in the treatment group compared to the control group. Taking ORS 1 day prior and until 2 hours before surgery decreased anxiety and discomfort, and alleviated hunger. Conclusion: Regarding complications, there was no difference in the incidence of aspiration and postoperative complications. There were fewer wound complications and incidence of paralytic ileus in the treatment group.
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