Effects of preoperative oral carbohydrate on postoperative insulin resistance in radical gastrectomy patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects and mechanism of postoperative insulin resistance in gastrectomy patients with preoperative oral carbohydrate.</p><p><b>METHODS</b>From April to October 2011, 60 consecutive gastric cancer patients met inclusion criteria were divided into oral carbohydrate group and placebo group by randomized double-blind principles. Resting energy expenditure (REE), fasting blood glucose, insulin and triglyceride level were detected in 4 hours preoperatively. The 500 ml carbohydrate or placebo were administrated orally 2-3 hours before anaesthesia. Two group patients underwent radical distal subtotal gastrectomy under epidural compounded intravenous anesthesia. After laparotomy and before the abdomen was closed, a piece of rectus abdominis was taken and fixed in 3% glutaraldehyde. REE, fasting blood glucose, insulin and triglyceride level were detected immediately after surgery. The changes of insulin resistance index, blood triglycerides level, REE and respiratory quotient were compared pre- and post-operatively. The changes of rectus abdominis mitochondrial ultrastructure were observed by transmission electron microscopy respectively.</p><p><b>RESULTS</b>There were 48 patients (34 males and 14 females) completed the trial. The 24 and 24 patients in oral placebo and carbohydrate groups respectively. In oral placebo group, post-operative insulin resistance index, REE, respiratory quotient, serum triglyceride level and the rectus abdominis mitochondrial damage index were 12.68 ± 3.13, (1458 ± 169) kcal/d, 0.73 ± 0.42, (0.53 ± 0.24) g/L and 1.14 ± 0.33, respectively. And the above items were 5.67 ± 1.40, (1341 ± 110) kcal/d, 0.79 ± 0.22, (1.04 ± 0.97) g/L and 0.92 ± 0.19 in oral carbohydrate groups respectively. All difference was statistically significant (t = 6.646, 2.851, 6.546, 2.542 and 2.730, all P < 0.05). Oral placebo group showed a markedly swollen mitochondria, steep membrane was not clear, mitochondria appeared vacuolated changes.</p><p><b>CONCLUSIONS</b>Preoperative oral carbohydrate could reduce the insulin resistance and REE, improve the material metabolism status in radical gastrectomy patients. The possible mechanisms should be related to promotion of insulin release and protection of mitochondrial function.</p>

Perioperative blood glucose control / 中华胃肠外科杂志

Hyperglycemia can result in severe adverse effects on the body. The mortality and morbidity of surgery are increased significantly in diabetic patients. The surgical stress-related hyperglycemia and insulin resistance can also produce the same adverse consequences. The metabolic state of the surgical patients, anesthesia method, glucose infusion, stress-induced neuroendocrine responses and insulin resistance can affect the perioperative blood glucose levels, resulting in poor clinical outcomes. The relationship between tight glycemic control and reducing post-operative mortality and morbidity is not clear. It's necessary to control blood sugar level during the perioperative period but the ideal state of glycemic control still needs a mult-center clinical trial evidence. It is generally believed that perioperative blood glucose level should be controlled below 10 mmol/L. The efficacy and safety of tight glycemic control needs further study.

Effect of different perioperative treatments on gut flora in SD rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effects of different perioperative treatments on the number and proportion of gut flora in SD rats.</p><p><b>METHODS</b>Forty-eight SD rats were randomized into 8 groups including the control group, antibiotics group, bowel preparation group, fasting group, antibiotic-bowel preparation group, antibiotics-bowel preparation-fasting group, bowel preparation-surgery-antibiotics-early postoperative feeding group (early feeding group), and bowel preparation-surgery-antibiotics-postoperative fasting group. The rats were sacrificed and stool specimens were collected from the cecum. Stools were diluted and transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared in terms of E.coli, Bacteroides, Bifidobacterium, and Enterococcus.</p><p><b>RESULTS</b>Compared with the control group, the total bacteria, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count and the bacillus/coccus ratio were significantly elevated(P<0.05). In the bowel preparation group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). In the fasting group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). Early postoperative feeding increased E.coli, Enterococcus, and total bacteria count(P<0.05), and lowered bacillus/coccus ratio(P<0.05) as compared to the fasting group.</p><p><b>CONCLUSIONS</b>Antibiotics, bowel preparation, and fasting have influence on the gut flora of SD rats in count and bacillus/coccus ratio, leading to dysbiosis. Early postoperative feeding may improve dysbiosis.</p>

Effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of intensive insulin therapy on resting energy expenditure in postoperative patients underwent radical distal gastrectomy.</p><p><b>METHODS</b>Sixty-four patients with gastric neoplasms in the middle or lower part of stomach from January to October 2010 were enrolled and underwent radical distal gastrectomy, then were randomized to intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or conventional insulin therapy (CIT) group to keep levels from 4.4 to 10.0 mmol/L. Resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilogram (REE/kg) and lipid oxidation ratio (LOR) were monitored by indirect energy metabolic system on preoperative and postoperative 1(st), 3(rd) and 7(th) day. Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment.</p><p><b>RESULTS</b>Compared with preoperative baseline, postoperative REE, REE/kg, LOR, Ln-HOMA-IR increased dramatically (P < 0.05, respectively). RQ decreased markedly (P < 0.05). Compared with group CIT, IIT reduced the REE/kg level [(27.2 ± 1.3) kcal/kg vs. (30.0 ± 1.5) kcal/kg, P = 0.008; (24.7 ± 1.4) vs. (25.7 ± 1.6) kcal/kg, P = 0.013]; and decreased the Ln-HOMA-IR score (P = 0.019 and 0.028) on postoperative 1(st) and 3(rd) day; IIT could decrease obviously the level of C-reaction protein level on postoperative 1(st) and 3(rd) day (P = 0.017, 0.006). The total protein and albumin concentration in IIT group were more than its levels in group CIT (P = 0.023, 0.009).</p><p><b>CONCLUSION</b>There are some benefits of IIT in reducing mean energy expenditure and the consumption of proteins, decreasing postoperative insulin resistance level in this small population underwent radical distal gastrectomy.</p>