ERAS中POC应用的研究进展

Research Progress of POC Application in ERAS

摘要: 加速康复外科(enhanced recovery after surgery, ERAS)中术前口服碳水化合物(preoperative oral carbohydrates, POC)作为一项重要的术前营养支持及代谢调控方式被越来越多的应用于临床实践当中。该措施打破术前长时间禁食、禁饮的传统观念，并以口服碳水化合物饮品的方式尽可能减小患者术前代谢应激。研究发现，术前10 h饮用12.5%碳水化合物饮品800 mL，术前2 h饮用≤400 mL可显著减轻术后患者的恶心呕吐，加快胃肠道恢复，降低胰岛素抵抗，减轻术后疼痛，提高患者的满意度及幸福感，且并未发现POC增加麻醉后误吸的风险。在不同种类饮品对比研究中发现，与单一碳水化合物饮品相比，术前饮用复合碳水化合物饮料可能没有额外的好处，而单一碳水化合物更易配制且价格低廉，相比之下单一碳水化合物饮品可能更适用于临床。现本文就POC的研究现状进行综述，旨在汇总梳理POC的研究进展，为其在临床的应用提供些参考依据。

Abstract: As an important preoperative nutritional support and metabolic regulation method in enhanced recovery after surgery (ERAS), preoperative oral carbohydrates (POC) has been more and more ap-plied in clinical practice. This measure breaks the traditional concept of long-time fasting and water deprivation before operation, and reduces preoperative metabolic stress as much as possible by oral carbohydrate drinks. The study found that drinking 12.5% carbohydrate drink 800 mL 10 h before surgery and ≤400 mL 2 h before surgery can significantly reduce postoperative nausea and vomiting, accelerate gastrointestinal recovery, reduce insulin resistance, reduce postoperative pain, and improve patients’ satisfaction and happiness. POC did not increase the risk of aspiration after anesthesia. In the study comparing different types of drinks, it was found that there may be no ad-ditional benefit of preoperative complex-carbohydrate drinks compared with single-carbohydrate drinks, which are easier to formulate and less expensive, and single-carbohydrate drinks may be more suitable for clinical use. This article reviews the research status of POC, aiming to summarize and sort out the research progress of POC, and provide some reference for its clinical application.