Clinical Study Of The Preoperative Oral Glucose Solution Attenuating Postoperative Insulin Resistance In Patients Undergoing Gastric Cancer Resection

Objective: 1. Observe the safety of clinical manifestation by preoperative oral 500 ml of 10% glucose solution in patients undergoing gastric cancer resection during perioperative period. 2. Observe the influence of postoperative IR and complications by preoperative oral 500 ml of 10% glucose solution in patients undergoing gastric cancer resection. 3. Discuss by applying the 2 hours preoperative oral carbohydrate only whether can promote early rehabilitation of patients after surgery. Methods: 33 patients from the first affiliated hospital of Wannan Medical Collage undergoing the D2 elective resection for gastric cancer were enrolled and randomized into three groups: group glucose(Group A), group distilled water(Group B) and group forbidden to drink(Group C). Patients in group A were given 500 ml of 10% glucose solution for oral intake two hours before surgery. In the group B, they were given distilled water instead of glucose. Also, patients in these two groups must drink their liquid in twenty to thirty minutes. In the third group, they drunk and ate nothing. For the patients in the three groups, in order to measure the amount of liquid remaining in the stomach, they had to be indwelled stomach tube before anesthesia to suck the gastric residual liquid, squeezed the gastric body to elicit the residual liquid fully by gastric tube leads. Patient’s wellbeing scores on a visual analogue scales(VAS) were recorded before they drunk their liquid(2 hours before surgery in group C) and thirty minutes before anesthesia. Blood samples were collected to measure the level of the serum concentration of blood glucose and insulin before they drunk their liquid, thirty minutes before anesthesia, immediate postoperative and the morning of the first day and the third day after surgery regularly. The insulin resistance index and the insulin sensitivity index were assessed by the homeostasis model assessment(HOMA). The occurrence of complications, the time of exhaustion and defecation and the length of postoperative hospital were recorded. The data was statistical analyzed with the spss13.0. We ruled P<0.05 means statistical difference, P<0.01 was considered statistical difference is significant. Results: 1.There were no differences in the feeling of anxiety between these three groups(P>0.05). No differences were observed about the volume of residual gastric contents, the occurrence of complications, the time of exhaustion and defecation and the length of postoperative hospital between the three groups(P>0.05). 2. The VAS scores of thirst in the group A and B before anesthesia were significantly lower than that before they drunk their liquid(P<0.05). The group C got no changes(P>0.05). The VAS scores of hunger in the group A before anesthesia was significantly lower than that before they drunk the glucose(P<0.05), which was significantly lower than the other two groups at the same time(P<0.05). 3. Regarding the blood glucose of group A, the levels increased rapidly before anesthesia, but became lower after the operation, and after one to three days, it returned to preoperative levels. Compared with group A, there is no any change for the serum concentration of glucose before anesthesia for group B and C, but after the operation, it increased a lot, and is higher than the blood glucose levels compared with group A(P<0.05). For the serum concentration of insulin, it is just a litter increasing for the group A and become lower after 3 days of operation. However, it increased apparently for the group B and C, even higher than the insulin levels compared with group A.(P<0.05) It became lower after 1 to 3 days, but still not meet the normal level. Regarding the HOMA-IR index, it increased a little, but still lower compared with other two groups,(P<0.05). The HOMA-IR index is lower after 1 to 3 days of operation, but still not returned to the normal range. However, the HOMA-IS is in the opposite. HOMA-IS indexes got the opposite results of the HOMA-IR. Conclusion: 1. The study shows it is safe and reliable there is no happening of complication such as aspiration, reflux, also there is no difference for the gastric residual volume compared with control group. 2. The study shows 500 ml of 10% glucose intake 2 hours before surgery can reduce the insulin resistance and increase insulin sensitivity. 3. There is no any significant effect on the postoperative rehabilitation by adopting the 2 hours preoperative oral carbohydrates.