术前口服碳水化合物的研究进展

Research Progress of Preoperative Oral Carbohydrate

摘要: 传统术前禁食指南要求患者“午夜后禁食”，其核心目的是降低麻醉期间胃内容物反流和误吸的风险。研究表明，长时间禁食非但不能带来额外安全获益，反而会诱发机体分解代谢，导致术前口渴、饥饿、焦虑等不适，并加剧手术创伤引发的胰岛素抵抗和应激反应，不利于术后康复。随着加速康复外科理念的普及，围术期管理正从被动规避风险转向主动优化患者生理状态。在此背景下，术前口服碳水化合物作为一种关键的代谢干预措施应运而生。它指在手术前2~3小时让患者饮用特定配方的碳水化合物清饮料，旨在将机体从“饥饿状态”调整为“饱腹状态”，以改善代谢、提升舒适度并促进术后恢复。这一实践正深刻改变着全球的围术期禁食管理策略。

Abstract: Traditional preoperative fasting guidelines require patients to “fast after midnight,” with the central aim of reducing the risk of gastric contents reflux and aspiration during anesthesia. Studies have shown that long-term fasting can not bring additional safety benefits, but can induce catabolism of the body, lead to preoperative discomfort such as thirst, hunger, anxiety, and aggravate insulin resistance and stress response caused by surgical trauma, which is not conducive to postoperative rehabilitation. With the popularity of enhanced recovery after surgery (ERAS), perioperative management is shifting from passive risk avoidance to active optimization of patients’ physiological state. In this context, preoperative oral carbohydrate has emerged as a key metabolic intervention. It involves giving patients a carbohydrate-based light drink formulated 2~3 hours before surgery, with the aim of rebalancing the body from a “hungry state” to a “full state” to improve metabolism, comfort, and postoperative recovery. This practice is profoundly changing perioperative fasting management strategies worldwide.