克利夫兰特邀述评：术前碳水化合物负荷
术前使用含碳水化合物的液体（通常碳水化合物占12%，主要是麦芽糊精）可为手术患者带来益处，被快速康复外科（ERAS）协会推荐作为综合治疗方案的一部分，以缩短手术患者住院时间、降低并发症。碳水化合物代谢受喂养状态影响较大，与传统的术前午夜禁食相反，术前2小时给予碳水化合物液体可激活该代谢。富含碳水化合物的液体已被证明可增加患者术前的舒适感，理论上可减轻胰岛素抵抗、降低分解代谢，对围手术期血糖控制和肌肉保存有积极作用。进一步假设认为该方法能促进达成快速康复外科降低并发症发生率和住院时间的目标。术前碳水化合物液体负荷难以证明有这些作用，因为手术方式及术后治疗更可能影响患者的结局。碳水化合物负荷方案的应用需要进一步充分的双盲、安慰剂对照研究，包括使用不同的手术方式、再现高胰岛素血症血糖控制正常的测定方法、调查理想的碳水化合物液体组成成分，比较时应采用相似的手术。术前碳水化合物负荷是与快速康复外科（ERAS）方案成功相关的众多措施之一。
Nutr Clin Pract. 2015;30(5):660-4.
Review of Preoperative Carbohydrate Loading.
Pogatschnik C, Steiger E.
Center for Human Nutrition & Center for Gut Rehabilitation and Transplantation, Department of General Surgery and Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
Preoperative carbohydrate-containing clear liquids (usually composed of approximately 12% carbohydrate predominantly in maltodextrin form) have provided benefits for the surgical population and further have been included in the Enhanced Recovery After Surgery (ERAS) Society's recommendations as part of a multimodal approach to reduce surgical patients' length of stay and complication rates. Carbohydrate metabolism is greatly affected by the fed state, which is activated by preoperative carbohydrate fluids given up to 2 hours prior to surgery in contrast to the traditional midnight preoperative fast. Carbohydrate-rich fluids have been proven to enhance patient comfort prior to surgery and have been theorized to reduce insulin resistance, reducing patient catabolism, with a positive impact on perioperative glucose control and muscle preservation. This practice is further hypothesized to support the ERAS goals of reducing both complication rate and length of stay. Preoperative carbohydrate fluid loading is difficult to prove, as the degree of surgical procedure and postoperative pathways are likely more reflective of patient outcome. The use of carbohydrate-loading protocols warrants further adequately blinded, placebo-controlled studies, including the use of variable surgical techniques, reproduction of the hyperinsulinemic euglycemic technique measurements, investigation of ideal carbohydrate fluid composition, and the use of similar surgeries in comparison. Preoperative carbohydrate loading is just one of the many strategies linked to the success of ERAS protocols.
KEYWORDS: carbohydrate metabolism; fasting; nutrition therapy; perioperative period; preoperative care; surgical procedures
PMID: 26197803
DOI: 10.1177/0884533615594013
翻译：天津市第三中心医院营养科肖慧娟