观察妇科腹腔镜手术围术期碳水化合物口服疗法和传统禁饮食方案两种不同的临床处理措施对于术后胰岛素抵抗（IR）的影响。

选取2018年2月至8月入住徐州医科大学附属医院妇科，行腹腔镜下全子宫切除手术的非糖尿病患者共98例，将采用围术期碳水化合物口服疗法者作为观察组（50例），采用传统禁饮食方案者作为对照组（48例）。检测所有病例的术前、术后第1天及第3天的空腹血糖（FPG）及空腹胰岛素（FINS），并利用稳态模式评估法计算稳态模型胰岛素抵抗指数（HOME-IR）。对于观察组与对照组患者术前、术后第1天和术后第3天的FPG、FINS和HOME-IR等指标，组间比较采用独立样本t检验。两组患者术后腹胀、术后24 h通气、术后发热的发生情况的比较采用确切概率法检验。

观察组与对照组比较，术前和术后第1天FPG差异无统计学意义（P均>0.05），术后第3天FPG明显降低［（4.34±0.59）mmol/L vs （4.96±0.64）mmol/L］，差异有统计学意义（t=-4.96，P=0.002）。观察组与对照组比较，术前和术后第1天FINS差异无统计学意义（P均>0.05），术后第3天FINS明显降低［（45.39±13.55）mIU/L vs （51.18±9.34） mIU/L］，差异有统计学意义（t=-2.46，P=0.033）。观察组与对照组比较，术前HOME-IR差异无统计学意义（P>0.05），术后第1天和术后第3天HOME-IR明显降低［（13.08±4.80）vs （15.03±4.11）；（9.37±3.65）vs （11.30±2.55）］，差异有统计学意义（t=-0.69，P=0.042；t=-3.99，P=0.033）。两组患者术后其他观察指标比较，观察组术后24 h通气率与对照组比较明显增高（76.0% vs 64.6%），差异有统计学意义（P=0.045）。两组患者在术后腹胀、术后发热的发生率方面差异无统计学意义（P均>0.05）。两组患者均未发生术中误吸。

妇科腹腔镜手术围术期应用碳水化合物口服疗法较传统禁饮食方案，能有效减轻术后IR程度，促进术后康复进程，且不增加围术期并发症的发生率。

To observe the effect of perioperative oral carbohydrate therapy and traditional diet regimen on insulin resistance (IR) in patients undergoing gynecological laparoscopic surgery.

A total of 98 non-diabetic patients admitted to the Department of Gynaecology, Affiliated Hospital of Xuzhou Medical University from February to August 2018 were selected for laparoscopic total hysterectomy. The patients receiving perioperative oral carbohydrate therapy were selected as an observation group (50 cases), and those receiving traditional diet regimen were included as a control group (48 cases). Fasting plasma glucose (FPG) and fasting insulin (FINS) before surgery and 1 and 3 days after surgery were detected in all cases, and the homeostasis model insulin resistance index (HOME-IR) was calculated by the homeostasis model evaluation method. The independent sample t-test was used to compare the parameters such as FPG, FINS, and HOME-IR between the two groups. The exact probability method was used to compare the incidence of abdominal distension, postoperative ventilation, and postoperative fever in the two groups.

There was no statistically significant difference in FPG between the observation group and the control group before and on the first day after surgery (P>0.05), while FPG was significantly reduced on the third day after surgery [(4.34±0.59) mmol/L vs (4.96±0.64) mmol/L, t=-4.96, P=0.002]. There was no significant difference in FINS (P>0.05) between the observation group and the control group before and on the first day after surgery, while the FINS [(45.39±13.55) mIU/L vs (51.18±9.34) mIU/L] on the third day after the operation was significantly reduced (t=-2.46, P=0.033). There was no statistically significant difference in HOME-IR between the observation group and the control group (P>0.05) before operation, but HOME-IR was significantly reduced on the first and third day after operation [(13.08±4.80) vs (15.03±4.11); (9.37±3.65) vs (11.30±2.55), t=-0.69, P=0.042; t=-3.99, P=0.033]. The ventilation rate of the observation group at 24 h after the operation was significantly increased compared with the control group (76.0% vs 64.6%, P=0.045). There was no significant difference in the incidence of postoperative abdominal distension or postoperative fever between the two groups (P>0.05). No intraoperative aspiration occurred in either group.

Compared with traditional dietary restriction, oral carbohydrate therapy during the perioperative period of gynecological laparoscopic surgery can effectively reduce the degree of IR after surgery and promote the postoperative rehabilitation, without increasing the incidence of perioperative complications.