The Reserch On The Relationship Between The Change Of Insulin Resistance In Perioperative Periods And Prognosis After Major Abdominal Surgery

Objective Perioperative insulin resistance (insulin resistance, IR) has been a research hotspot in recent years. IR is very common in the perioperative period, the IR will have serious negative impacts。IR will have serious negative impacts.affect post-traumatic energy supply of the high metabolic, significantly reduce body anti-infective, anti-shock capability and also affect wound healing.Some studies even show that the hyperlycemia caused by IR was associated with mortality. In recent years, with the homeostasis model assessment (HOMA-2) clinical applications, the software can be simple and convenient measure of insulin resistance index. Some of the literature reported clinical studies at home and abroad recently,mostly from the perspective of prevention and treatment of IR, to seek best methods to reduce perioperative surgical stress and reduce postoperative IR, and postoperative complications. Thereby improving the prognosis for patients with rapid recovery, shorter hospital stay. But no matter what kind of methods are based on observations that research of perioperative insulin resistance influential factors,changes,and relationship with prognosis.In this study,36 patients with major abdominal surgery were taken to observe the object, to investigate the relationship between Perioperative insulin resistance index and Prognosis,which provide a theoretical basis for other research on reduce perioperative stress response.Methods 36 patients(21 males,15 females) aged 36-84yr weighing 38-87 kg without Endocrine and metabolic diseases in our hospital undergoing major abdominal surgery, they were selected to use latest available data of our laboratory before surgery,and combined with physiological and operative severity score of POSSUM score to evaluate Preoperative and surgical conditions.we also used HOMA-2 to calculate insulin resistance index on Preoperative day, the day of after surgery,and Postoperative 1,3,7 days. ordered the absolute difference (|IR the day of after surgery,-IR Preoperative day|) from small to large, and used P50=0.70 as the cutoff value to divided into equal number of cases large group and Small group according to fluctuations of insulin resistance index. Recovery time of postoperative bowel,anal exhaust time for the first time, postoperative complications were also recorded.Results1. Compared to all patients before and after surgery,the IR index was significantly higher then before in the day of after surgery and postoperative 1-3 days (P<0.05). The IR index returned to preoperative levels in Seventh day after surgery(P>0.05).2. There was no difference between the two groups in general information before surgery. Compared with the two groups,there was significant difference in operative severity score (OSS score), operation time, blood loss and incision length.The Degree of operative trauma in group L was larger than in group S.3. Compared to L group,S group has no significant difference in intestinal function recovery time,but it has lower incidence of postoperative complications (P<0.05).4. Use the insulin index fluctuations as dependent variable,and preoperative and surgery-related factors as independent variables to do a Logistic regression analysis.Olny the OSS score and blood loss into the regression equation, Shows that the degree of surgical invasion and blood loss are the main factors affect the insulin resistance fluctuations.5. Use the postoperative complications as dependent variables, and preoperative and surgery-related factors as independent variables to do a Logistic regression analysis. PS score and preoperative IR index fluctuated into the regression equation, indicating that preoperative physical condition, and surgery caused insulin resistance index fluctuations of patients, are risk factors for postoperative complications.Conclusion Insulin resistance index fluctuations after major abdominal surgery is one of the main risk factors of postoperative complications occurred. The size of insulin resistance index fluctuations affected by operative severity and blood loss volume.