Ameliyat öncesi oral karbonhidrat verilmesinin ameliyat sonrası insülin direncine etkisi
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Date
2003
Authors
Güner, Osman Serhat
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Publisher
Uludağ Üniversitesi
Abstract
Amaç : Bu çalışmada, ameliyat öncesi oral karbonhidrat verilmesinin ameliyat sonrası dönemde insülin direncine, hastanede kalış süresine ve metabolik yanıta olan etkisi araştırılmıştır. Yöntem : Etik kurul izni alındıktan sonra, elektif kolorektal cerrahi uygulanan, diabetes mellitus ve belirgin yandaş hastalığı olmayan toplam 20 olgu (grup 1: 10, grup 2: 10) prospektif randomize olarak çalışmaya alındı. Kontrol grubundaki olgular ameliyat öncesi gece boyunca açlığı takiben ameliyat edilirken, çalışma grubundaki olgulara ameliyat öncesindeki gece 800 ml. ve anestezi başlangıcından 2 saat öncesine kadar da 400 ml. olmak üzere toplam 1200 ml. (600 kcal. ) izoosmolar karbonhidrat solüsyonu (Nutricia Preop ® %12,5) verilmesini takiben ameliyat edildiler. Her iki grupta da ameliyat öncesi ve ameliyat sonrası 1. , 8. saat ve 2, 3, 5, 7. günlerde serum glukoz, insülin ve C-Peptit düzeyleri çalışıldı. Homeostasis Model Assesment (HOMA ) yöntemiyle insülin direnci hesaplandı. Her iki grubun insülin direnci, oral gıda alımına geçiş süreleri ve oral gıda alımdaki sorunlar, barsak sesleri, oluşan komplikasyonlar ve hastanede kalma süreleri karşılaştırıldı. Bulgular : İki grup arasında yaş,anestezi süresi ve ameliyat öncesi insülin direnci açısından fark yoktu. Çalışma grubunda morbidite ve mortalite oluşmaz iken, kontrol grubunda 1 hastada anastomoz kaçağı gelişti ve tekrar ameliyat edildi. Bir hasta evisserasyon nedeni ile tekrar ameliyat oldu. lnsülin direnci ve hastanede kalış süreleri çalışma grubunda belirgin olarak düşük bulundu (p<0.05). Sonuç : Ameliyat öncesi uygulanan oral karbonhidrat solüsyonu ameliyat sonrası dönemde gelişen insülin direncini önemli ölçüde azaltmış ve nekahata geçiş süresini kısaltmıştır.
Aim : The study is designed to investigate the effect of preoperative administration of oral carbohydrates on postoperative insulin resistance, metabolic response and hospital stay . Method : After approval of ethical comittee was taken 20 patients, (group 1:10, group 2: 10) who had undergone elective colorectal surgery and who had no evidence of diabetes mellitus or concurrent systemic diseases, were evaluated in a prospective , randomized manner. Patients in control group were taken to the operating room after of the night fast before surgery, whereas , patients in study group took oral 800 mis of isoosmolar carbohydrate solution (Nutricia Preop ® %12,5 ) along the night before surgery and 400 ml of the same solution 2 hours before induction of anesthesia (1200 mis in total) and than were taken to the operation. Serum glucose, insulin and C-Peptide levels were measured preoperatively and on 1st and 8th hours and 2nd, 3rd, 5th and 7th days of surgery. lnsulin resistance was calculated by means of HOMA ( Homeostasis Model Assesment ) method. lnsulin resistance, time of recovery of oral food intake and intestinal motility, problems in enteral nutrition, complications and times of hospital stay for two groups were compared. Results : There were no significant difference between two groups in age, time of anesthesia and preoperative insulin resistance. No mortality or morbidity occured in the study group, whereas one patient in control group was reoperated for anostomotic leakage. One patient was reoperated for evisseration. lnsulin resistance and time of hospital stay was signifıcanthy tower in the study group (p< 0,05). Conclusion: Preoperative administration of oral carbohydrate solution signifıcanthy decreases postoperative insulin resistance and time of recovery.
Aim : The study is designed to investigate the effect of preoperative administration of oral carbohydrates on postoperative insulin resistance, metabolic response and hospital stay . Method : After approval of ethical comittee was taken 20 patients, (group 1:10, group 2: 10) who had undergone elective colorectal surgery and who had no evidence of diabetes mellitus or concurrent systemic diseases, were evaluated in a prospective , randomized manner. Patients in control group were taken to the operating room after of the night fast before surgery, whereas , patients in study group took oral 800 mis of isoosmolar carbohydrate solution (Nutricia Preop ® %12,5 ) along the night before surgery and 400 ml of the same solution 2 hours before induction of anesthesia (1200 mis in total) and than were taken to the operation. Serum glucose, insulin and C-Peptide levels were measured preoperatively and on 1st and 8th hours and 2nd, 3rd, 5th and 7th days of surgery. lnsulin resistance was calculated by means of HOMA ( Homeostasis Model Assesment ) method. lnsulin resistance, time of recovery of oral food intake and intestinal motility, problems in enteral nutrition, complications and times of hospital stay for two groups were compared. Results : There were no significant difference between two groups in age, time of anesthesia and preoperative insulin resistance. No mortality or morbidity occured in the study group, whereas one patient in control group was reoperated for anostomotic leakage. One patient was reoperated for evisseration. lnsulin resistance and time of hospital stay was signifıcanthy tower in the study group (p< 0,05). Conclusion: Preoperative administration of oral carbohydrate solution signifıcanthy decreases postoperative insulin resistance and time of recovery.
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Keywords
Oral karbonhidrat, Ameliyat sonrası insülin direnci, Oral carbohydrate, Postoperative insulin resistance
Citation
Güner, O.S. (2003). Ameliyat öncesi oral karbonhidrat verilmesinin ameliyat sonrası insülin direncine etkisi. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.