探讨术前口服碳水化合物对ERCP术后患者胰岛素抵抗及心理康复的影响。

本前瞻性研究对象为2017年1月至2018年12月上海交通大学医学院附属新华医院行ERCP治疗的120例患者。患者均签署知情同意书，符合医学伦理学规定。其中男67例，女53例；平均年龄（67±17）岁。按随机数字表法随机分为观察组和对照组，每组60例。观察组患者术前晚、术前2 h分别口服10%葡萄糖溶液1 000、500 ml。对照组术前8 h禁食，6 h禁水。观察两组患者术中误吸情况，围手术期血胰岛素浓度、稳态模式的胰岛素抵抗指数（HOMA-IR）、焦虑自评量表（SAS）评分、住院时间等。两组患者围手术期情况比较采用t检验。

两组均顺利完成ERCP操作，无发生误吸。术后3 h观察组胰岛素浓度、HOMA-IR分别为（8.6±2.7）mmol/L、（2.8±1.2）mU/L，明显低于对照组的（14.2±3.7）mmol/L、（4.8±1.5）mU/L（t=-2.91，-2.62；P<0.05）。术后1 d观察组胰岛素浓度、HOMA-IR分别为（9.1±2.6）mmol/L、（2.9±1.1）mU/L，亦明显低于对照组的（15.1±4.1）mmol/L、（5.1±1.7）mU/L （t=-2.74，-2.95；P<0.05）。术后观察组SAS评分为（32±6）分，明显低于对照组的（38±8）分（t=-2.98，P<0.05）。观察组在护理满意度、治疗依从性及生活质量评分分别为（94±5）、（92±5）、（91±5）分，均明显高于对照组的（83±5）、（80±4）、（79±5）分（t=2.46，2.85，2.74；P<0.05）。观察组住院时间为（5.6±2.2） d，明显短于对照组的（7.6±4.1）d（t=-3.31，P<0.05）。

ERCP术前口服碳水化合物不增加误吸等手术并发症的风险，同时可减轻胰岛素抵抗，缓解术后焦虑情绪，缩短住院时间，加速患者康复。

To explore the effects of preoperative oral carbohydrate on patients with post-ERCP insulin resistance and psychological recovery.

The subjects of this prospective study were 120 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2018. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 67 patients were male and 53 female, with a mean age of (67±17) years. Patients were randomly assigned to the observation group and the control group according to the random number table method with 60 cases in each group. 1 000 ml and 500 ml of 10% glucose solution were given orally to the patients in observation group on the night before surgery and 2 h before surgery respectively. Patients in control group were on fasting for 8 h and deprived of water for 6 h preoperatively. Intraoperative aspiration, as well as perioperative blood insulin concentration, homeostasis model assessment-insulin resistance (HOMA-IR), self-rating anxiety scale (SAS), and length of hospital stay in patients of both groups were observed. Perioperative status of two groups was compared using t test.

ERCP were successfully performed in both groups without aspiration. The insulin concentration and HOMA-IR at postoperative 3 h in observation group were (8.6±2.7) mmol/L and (2.8±1.2) mU/L, which were significantly lower than (14.2±3.7) mmol/L, (4.8±1.5) mU/L in control group (t=-2.91, -2.62; P<0.05). The insulin concentration and HOMA-IR on postoperative 1 d in observation group were (9.1±2.6) mmol/L and (2.9±1.1) mU/L, significantly lower than (15.1±4.1) mmol/L, (5.1±1.7) mU/L in control group (t=-2.74, -2.95; P<0.05). The postoperative SAS in observation group was 32±6, significantly lower than 38±8 in control group (t=-2.98, P<0.05). The score for nursing satisfaction, treatment compliance, and quality of life in observation group was 94±5, 92±5, and 91±5, respectively, which were significantly higher than 83±5, 80±4, and 79±5 in control group (t=2.46, 2.85, 2.74; P<0.05). The length of hospital stay in observation group was (5.6±2.2) d, significantly shorter than (7.6±4.1) d in control group (t=-3.31, P<0.05).

Pre-ERCP oral carbohydrate does not increase the risk of surgical complications such as aspiration, while reducing insulin resistance, relieving postoperative anxiety, shortening hospital stay, and accelerating patient recovery.