The effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection / 中国医师进修杂志

ABSTRACT

Objective To assess the effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection.Methods Sixty patients with elective gastroenteric tumor resection were divided into preoperative carbohydrate preconditioning group and control group by random digits table with 30 cases each.Preoperative carbohydrate preconditioning group was given oral containing 50 g glucose carbohydrate 300 ml 2 h before surgery,and control group was given traditional method,fasting 12 h before surgery and water deprivation 6 h before surgery.The blood samples were collected to measure the level of fasting blood glucose (FBG),fasting insulin (FINS),interleukin (IL)-6 and C-reactive protein (CRP),3 h before surgery and 1,3,7 d after surgery respectively.Homeostasis model assessment insulin resistance index (HOMA-IR) was computed.Results There were no statistical differences in FBG,FINS,IL-6,CRP and HOMA-IR 3 h before surgery between the 2 groups (P ＞ 0.05).The FBG,FINS,IL-6,C RP and HOMA-IR in the 2 groups at 1,3 d after surgery were significantly higher than those 3 h before surgery,but those except for FBG in control group were significantly higher than those in preoperative carbohydrate preconditioning group [1 d after surgery(39.67 ± 10.37) mU/L vs.(25.78 ± 12.43) mU/L,(98.67 ± 12.42) μg/L vs.(65.36 ± 16.72)μg/L,(121.74 ±11.32) mg/L vs.(82.18 ±4.36) mg/L,19.07 ±5.49 vs.11.67 ±6.32;3 d after surgery(24.34 ±6.78) mU/L vs.(16.23 ±7.56) mU/L,(116.43 ± 18.57) μg/L vs.(78.53 ± 10.38) μg/L,(151.30 ± 10.46) mg/L vs.(129.29 ± 10.24) mg/L,8.56 ±2.87 vs.5.12 ±2.11],there were statistical differences (P ＜0.05).There were no statistical differences in FINS and HOMA-IR in preoperative carbohydrate preconditioning group between 7 d after surgery and 3 h before surgery (P ＞ 0.05),but there was statistical difference in control group (P＜ 0.05).There were no statistical differences in FBG,IL-6 and CRP in the 2 groups between 7 d after surgery and 3 h before surgery (P ＞ 0.05).There was no aspiration during anesthetic stage.Conclusion Preoperative carbohydrate preconditioning may shorten the insulin resistance time after gastroenteric tumor resection,reduce the intensity of insulin resistance,and improve inflammatory response,thus contributing to the rehabilitation of patients.