2025 年第 8 期 第 20 卷

术前碳水化合物对老年患者骨科高危手术围手术期应激反应和术后认知功能的影响

The effects of preoperative carbohydrate intake on perioperative stress response and postoperative cognitive function in elderly patients undergoing high-risk orthopedic surgery

作者：支晓雁魏晓廖家齐李进高韵婷田毅

英文作者：Zhi Xiaoyan Wei Xiao Liao Jiaqi Li Jin Gao Yunting Tian Yi

单位：海南省海口市人民医院麻醉手术部，海口570208

英文单位：Department of Anesthesia Surgery Haikou People′s Hospital Hainan Province Haikou 570208 China

关键词：老年骨科手术；术前碳水化合物补充；应激反应；术后认知功能障碍

英文关键词：Elderlyorthopedicsurgery;Preoperativecarbohydratesupplementation;Stressresponse;Postoperativecognitivedysfunction

• 摘要：

• 目的 探讨术前碳水化合物对老年患者骨科高危手术围手术期应激反应和术后认知功能的影响。方法 纳入2022年1月至2024年12月在海南省海口市人民医院接受骨科高危手术的老年患者221例。根据术前处理方式将患者分为观察组（94例，术前2 h饮用碳水化合物饮料）、饮水组（62例，术前2 h饮用等量温开水）和对照组（65例，术前禁食禁饮）。比较3组患者不同时点的生理代谢指标［血糖、胰岛素、胰岛素抵抗指数、促肾上腺皮质激素(ACTH)］、术后认知功能［简易精神状态检查量表（MMSE）评分］、术后恢复质量（QoR-40评分）、并发症及胃容量变化。结果  3组T3时点（术后次日晨8：00）血糖、ACTH水平比较差异均有统计学意义（均P＜0.001）。3组术前术后MMSE评分比较差异均无统计学意义（均P＞0.05）。观察组术后认知功能障碍（POCD）发生率显著低于对照组（P＜0.01）。多因素Logistic回归分析结果显示，年龄、术前MMSE评分、分组均是患者POCD发生的独立影响因素（均P＜0.05）。观察组、饮水组、对照组QoR-40评分比较［192(189,196)、180(173,186)分比162(156,169)分］，差异有统计学意义（P＜0.001）。各组反流误吸、恶心呕吐发生率比较，差异均无统计学意义（均P＞0.05）。结论  术前碳水化合物补充可有效减少老年骨科高危手术患者的围手术期应激反应，改善术后恢复质量，并降低POCD的发生率，同时不增加术后并发症风险。

• Objective To investigate the effects of preoperative carbohydrate intake on perioperative stress response and postoperative cognitive function in elderly patients undergoing high-risk orthopedic surgery. Methods A total of 221 elderly patients who underwent high-risk orthopedic surgery in Haikou People′s Hospital, Hainan Province from January 2022 to December 2024 were enrolled. According to the preoperative treatment methods , the patients were divided into observation group (94 cases, drinking carbohydrate beverage 2 h before surgery), drinking water group (62 cases, drinking the same amount of warm water 2 h before surgery) and control group (65 cases, fasting and water deprivation before surgery). The physiological metabolic indexes ［blood glucose, insulin, insulin resistance index, adrenocorticotropic hormone (ACTH)］, postoperative cognitive function ［mini-mental state examination (MMSE) score］, postoperative quality of recovery (QoR-40 score), complications and gastric volume changes were compared among the three groups at different time points. Results There were significant differences in blood glucose and ACTH levels among the three groups at T3 time point(8：00 the next day after surgery)(all P<0.001). There was no significant difference in MMSE scores among the three groups before and after operation (all P>0.05). The incidence of postoperative cognitive dysfunction (POCD) in the observation group was significantly lower than that in the control group (P＜0.01). Multivariate Logistic regression analysis showed that age, preoperative MMSE score and grouping were independent influencing factors for the occurrence of POCD (all P＜0.05). The QoR-40 scores of the observation group, drinking water group and control group were 192(189,196), 180(173,186) and 162(156,169), and the difference was statistically significant (P＜0.001). There was no significant difference in the incidence of reflux, aspiration, nausea and vomiting among the groups (all P＞0.05). Conclusion Preoperative carbohydrate supplementation can effectively reduce the perioperative stress response of elderly patients undergoing high-risk orthopedic surgery, improve the quality of postoperative recovery, and reduce the incidence of POCD without increasing the risk of postoperative complications.