| Backgroud: Fasting before surgery is still common care in a lot of domestic hospitals. Overnight fasting can induce postoperative insulin resistance. Postoperative insulin resistance is a well-characterized metabolic state that has been shown to correlate with the length of postoperative stay (LOS) in hospital. Preoperative intravenous or oral carbohydrate treatment has been shown to attenuate the development of postoperative insulin resistance measured on the first day after surgery.Objective: The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration, to investigate its effect on immediate postoperative insulin resistance, to elucidate whether the provision for utilizable energy can minimize loss of lean tissue brought about by increased gluconeogenesis and affect fluid homeostasis immediately after surgery, and to analyze their potential mechanism.Methods: 36 patients admitted to the Sixth People Hospital in Shanghai for elective colorectal cancer resection were recruited to this randomized controlled study and 32(20 male: 12 female) completed it. These 32 patients were randomly assigned to two groups, which were subdivided into: Control Group A (n=16, 11 male: 5 female); Test Group B (n=16, 9 male: 7 female). Group A were fasted, while B were given oral carbohydrate 3h before surgery and had to completely consume two hours before surgery while the procedure must be more than 20 minutes.Patient's wellbeing scores on a visual analogue scale(VAS) were recorded at 3 PM the day before operation and 2h after consuming carbohydrate-containing fluid respectively. Body compositions were measured by bioelectrical impedance analyzer (BIA- 101) 4h before surgery and immediately after surgery, respectively; At the same time, blood sample were collect to measure the level in plasma of blood glucose by automatic biochemistry analyzer, the serum concentrations of insulin, growth hormone, IGF-1, glucagons and cortisone by automatic chemiluminescence immune assay analyzer. Homeostasis model assessment (HOMA) was applied to assess the status of insulin resistance (HOMA-IR), basic function of pancreaticβcell (HOMA-βcell) and insulin sensitivity index (ISI). Rectus abdominis muscle were incided a little to measure the activity of PTK by PTK101 assay kit and the expression of PKB, PI3K and GluT4 by RT-PCR and Western Blot after the peritoneum were sutured.Data are presented as mean±SD and analyzed with SPSS 11.5 for Windows. Statistical analysis was performed using the Student's t-test and Chi-square test. P<0.05 was considered statistically significant.Results:⑴Patients were well-matched in terms of gender and age.⑵There were no differences between the two groups at baseline before surgery for wellbeing scores, body compositions, concentrations of blood glucose, insulin, growth hormone, IGF-1, glucagons, cortisone or procedure of anaesthesia and surgery.⑶Patients consumed carbohydrate-rich beverage before surgery reduced thirst, hunger, anxiety compared with fasting before surgery; With regard to feelings of nausea, tiredness and weakness, no changes were observed. No complications were recorded as a result of pre- operative fluid consumption. postoperative morbidity occurred in 6 and 5 patients respectively in Group A and Group B.⑷Being opposite to a decrease in the concentration of ISI immediate after surgery in both Group, the concentrations of blood glucose, insulin, HOMA-IR, glucagons, GH and cortisone all increased, and Group A changed significantly when compared with Group B. IGF-1 in Group A was lower significantly after surgery while no changes in Group B. There were no differences between the two groups for HOMA-βcell.⑸All parameters of body compositions after surgery in both Group were decreased except ECW/TBW. The value of ECW/TBW in Group A was higher than Group B but with no statistic significance.⑹The activities of PTK is higher than in Group B when compared with Group A, and it's the same to the expression of PKB, PI3K. No changes were observed about GluT4 measured by RT-PCR in both Groups.⑺the corrected length of postoperative stay was 18.56±9.44 days in Group A and 13.44±1.99 days in Group B. Statistically significant differences were found between two groups.Conclusion: Preoperative consumption of carbohydrate-containing fluids is safe and effective. Provision of carbohydrate energy source prior to surgery may attenuate immediate postoperative insulin resistance and reduce postoperative hospital stay but not the depletion of muscle mass or fluid homeostasis. A carbohydrate-rich drink enhances insulin action at the time of onset of anaesthesia or surgery by activating three kinases named PTK, PKB and PI3K which are key enzymes in the pathway of insulin signal transduction. It is likely to, at least partly, explain the effects on postoperative insulin resistance. |
PDF Full Text Request