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冠動脈バイパス移植を受けた糖尿病患者のインスリン抵抗性および術後の回復に対する術前経口炭水化物の効果: 予備的な見通し,単盲,ランダム化制御試験
Shicheng Zhang1, Lixian He2, Yiping Yu3
1Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Journal of cardiothoracic and vascular anesthesia
|September 3, 2025
まとめ
心臓手術を受けた糖尿病患者の手術前の炭水化物 (CHO) の摂取は炎症を軽減したが,インスリン抵抗性を有意に改善しなかった. CHOを明確にするためにさらなる研究が必要である.
科学分野:
- 心血管外科
- 代謝医学
- 手術 栄養
背景:
- 心臓外科手術を受ける非糖尿病患者には,インスリン抵抗性 (IR) と回復の改善により,手術前の口服炭水化物 (CHO) が有益です.
- オフポンプ冠動脈バイパス移植 (OPCAB) を受けている糖尿病患者に対する手術前CHOの影響は十分に理解されていません.
研究 の 目的:
- 術前CHOがOPCABを受けた糖尿病患者のIRと術後の回復に及ぼす影響を調査する.
主な方法:
- OPCABを受けている62人の糖尿病患者を対象とした予見性,単盲,ランダム化制御試験です.
- 患者は手術の8~12時間前に炭水化物飲料 (CHOグループ) を飲んだり,通常の断食 (対照グループ) を飲んだりしました.
- 主要エンドポイントは術後のIRであり,次要エンドポイントは炎症マーカーとストレス反応でした.
主要な成果:
- 術前のCHOは,術後の炎症マーカーを著しく減少させた.
- インスリン抵抗性 (IR) は,CHO投与によって有意に改善されなかった.
- ストレス反応は弱まり,CHO群では術後の排水量が高かったが,他の臨床結果では有意な差異はなかった.
結論:
- 手術前CHOは,OPCABを受ける糖尿病患者の炎症とストレス反応を弱める可能性があります.
- この集団におけるインスリン抵抗性 (IR) に対する手術前CHOの効果は不明である.
- CHOの投与は,OPCABを受けた糖尿病患者の手術後のリスクを増加させなかった.
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