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目的:探讨胃癌围手术期能量及营养物质的代谢特点,研究强化胰岛素治疗对围手术营养代谢的影响。方法:选取胃中、下部癌病理诊断明确并且外科病房ICU住院时间不少于24h的患者64例,取得知情同意后随机分到强化胰岛素治疗(IIT)组血糖控制在4.4~6.1mmol/L,和传统治疗(CIT)组血糖控制在10mmol/L以下;应用CCM营养代谢监测系统测定围手术期静息能量消耗(REE),呼吸商(RQ),每公斤体重静息能量消耗(REE/kg)和脂肪氧化比率,应用多频人体生物电阻抗分析仪测定围手术期人体组分的变化及应用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR)。结果:64例病人入选,每组32例,手术创伤引起术后第1、3天REE水平增加约22%和12%,呼吸商降低至0.759和0.791,REE/kg增加28kcal/kg和26kcal/kg,脂肪氧化比率增加至78%和65%,Ln-HOMA-IR明显增加(P<0.05);IIT治疗能降低术后第1、3天Ln-HOMA-IR和REE/kg水平;术后人体指标如细胞内液、脂肪组织、蛋白组织、肌肉组织、瘦体组织和体质量较术前水平明显降低(P<0.05);IIT能明显减少脂肪组织、蛋白组织和细胞内液的消耗量(P=0.009,t=0.026)。结论:IIT能够有效降低胃癌围手术期胰岛素抵抗程度、降低静息能量消耗的水平和减少脂肪及蛋白质的消耗。
Objective: To investigate the perioperative energy and nutrient metabolism characteristics of gastric cancer and to study the effect of intensive insulin therapy on perioperative nutritional metabolism. Methods: Sixty-four patients with definite pathological diagnosis of lower and middle gastric cancer and hospitalized in ICU of surgical wards of not less than 24h were enrolled in this study. Glucose control was 4.4 ~ 6.1mmol / L in IIT group with informed consent, And traditional therapy (CIT) were below 10mmol / L. The CCM nutrition and metabolic monitoring system was used to measure perioperative resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kg body weight (REE / kg ) And the ratio of fat oxidation, the application of multi-frequency human bioelectrical impedance analyzer to measure perioperative changes in human body composition and application of steady-state model assessment of insulin resistance index (HOMA-IR). RESULTS: Sixty-four patients were enrolled in this study. Each group consisted of 32 patients. Surgical trauma increased REE levels by about 22% and 12% on days 1 and 3, decreased respiratory quotient to 0.759 and 0.791, increased REE / kg by 28 kcal / kg and 26 kcal / kg, Ln-HOMA-IR significantly increased (P <0.05); the IIT treatment reduced the level of Ln-HOMA-IR and REE / kg on the 1st and 3rd postoperative day Body indexes such as intracellular fluid, adipose tissue, protein tissue, muscle tissue, lean body mass and body weight were significantly lower than preoperative levels (P <0.05); IIT could significantly reduce adipose tissue, protein tissue and intracellular fluid consumption (P = 0.009, t = 0.026). Conclusion: IIT can effectively reduce perioperative insulin resistance in gastric cancer, reduce the level of resting energy expenditure and reduce the consumption of fat and protein.