目的    采用网状Meta分析评价术前糖预处理对比其他术前干预措施减轻术后胰岛素抵抗的价值。 方法    检索中国期刊全文数据库（1994-2011年）、中国生物医学文献数据库（1978-2011年）、中文科技期刊全文数据库（1989-2011年）、数字化期刊全文数据库（1997-2011年），利用网状Meta分析的方法，纳入术前糖预处理、术前禁食水、术前安慰剂和术前静滴葡萄糖影响手术病人术后第1天血糖、血胰岛素水平和胰岛素抵抗程度的随机对照研究，评价不同的术前干预措施对减轻术后胰岛素抵抗的价值。数据采用ADDIS软件进行分析。 结果    共纳入7项研究（612例病人）。网状Meta分析结果显示，术前糖预处理、术前禁食水、术前安慰剂（水）和术前静滴葡萄糖，比较病人术后第1天血糖和血胰岛素水平、胰岛素抵抗程度和胰岛素敏感程度差异无统计学意义，尽管排序结果显示不同的干预措施对不同的结果指标影响不一样。 结论    目前术前糖预处理、术前静滴葡萄糖和术前安慰剂代替术前禁食水尚无有力证据支持，尚须进一步大样本、严格的随机对照研究。

Preoperative carbohydrate loading for reducing postoperative insulin resistance based on a network Meta-analysis    TIAN Jin-hui*, LI Lun, TIAN Hong-liang，et al. *Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000，China
Corresponding author ：YANG Ke-hu，E-mail：kehuyangebm2006@126.com
Abstract    Objective    Available preoperative carbohydrate loading for reducing postoperative insulin resistance was inconsistent, so it is necessary to conduct a net-work Meta-analysis to evaluate its effects vs. other preoperative interventions. Methods    China Journal Full-text Database（1994-2011）, Chinese Biomedical Database（1978-2011）, Chinese Scientific Journals Full-text Database（1989-2011）, and CMA Digital Periodicals（1997-2011）were searched to include all available randomized controlled trials about the effects of preoperative carbohydrate loading, fasting overnight, placebo and i.v. glucose on serum glucose and serum insulin at the first day, and the degree of insulin resistance. We used the methods of network Meta-analysis to assess the values of different preoperative interventions on serum insulin with ADDIS software.  Results    Seven trials (612 patients) were included. The results of network Meta-analysis showed that there were not any statistical differences in serum glucose and serum insulin levels at the first day, insulin sensitive index, and insulin resistance index, although the ranking results showed that they might have different effects for different outcomes.  Conclusion    Available evidence can not support that preoperative carbohydrate loading, placebo and i.v. glucose could replace fasting overnight, so further larger, more rigor randomized controlled trials should be conducted.