Effect of preoperative carbohydrate treatment on patients in Enhanced Recovery After Surgery / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the safety of preoperative oral carbohydrate treatment for the patients in Enhanced Recovery After Surgery (ERAS) and the treatment effect on the perioperative state of the patients.Methods A prospective controlled research was conducted in the patients who had received selective operation for fractures at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from August 2016 to August 2017.They were divided into 2 groups according to the floor where they stayed.In the traditional fasting group (group TF),fasting was performed one day before operation at 1200 p.m.;in the preoperative carbohydrate treatment group (group PCT),12.6％ mahodextrin fructose beverage was indicated one day before operation and on the day of operation.The patients in both groups were managed according to ERAS requirements perioperatively.The fasting blood glucose values were measured at admission,just before operation,immediately after operation,and on the next day after operation.The subjective feelings,grip strength and adverse reactions in the 2 groups were observed and recorded.Results A total of 171 patients,112 in group TF and 59 in group PCT,participated in the whole observation.The blood gluco.se value just before operation in group PTC(5.9 ± 1.0 mmol/L) was significantly higher than that (5.2 ±0.6 mmol/L) in group TF (P ＜ 0.05).In group TF,the blood glucose values immediately before operation,immediately and on the next day after operation (5.2 ± 0.6 mmol/L,5.4 ± 1.1 mmol/L and 5.4 ± 1.0 mmol/L) were significantly lower than that at admission (5.7 ± 1.1 mmol/L) (P ＜ 0.05);in group PTC,the blood glucose values immediately and on the next day after operation (5.4 ±0.7 mmol/L and 5.2 ±0.7 mmol/L) were significantly lower than those immediately before operation and at admission (5.9 ± 1.0 mmol/L and 5.9 ± 1.0 mmol/L) (P ＜0.05).Patients in group PTC reported milder uneasy subjective feelings than those in group TF.The grip strength values immediately and on the next day after operation in group PTC (34.3 ± 10.4 kg and 34.5 ± 10.9 kg) were higher than those in group TF (29.1 ± 13.1 kg and 30.1 ± 12.0 kg).Patients in group PCT showed higher satisfaction with perioperative fasting management than those in group TF [9 (9,9) versus 8 (7,9)].All the above differences were significant (P ＜ 0.05).Conclusion Preoperative carbohydrate treatment by oral intake of maltose and fructose drinks may be safe and feasible in fracture patients,benefiting their energy storage during fasting and improving their perioperative subjective feelings.