The Research Of Intensive Insulin Therapy On Insulin Resistance After Radical Gastrectomy

Objective To investigate the influence of intensive insulin therapy on insulin resistance after radical gastrectomy.Methods 22 gastric cancer patients were randomly divided into intensive insulin therapy and control group(n=11 respectively),and underwent distal radical subtotal gastrectomy under epidural anesthesia. After operation,the level of fasting blood glucose was kept between 4.4 and 6.1 mmol/l in intensive insulin therapy group and between 6.1 and 11.1 mmol/l in control one.Fasting blood glucose(FBG),insulin(FINS), C-reactive protein(CRP) and serum proteins levels were assayed preoperatively and on 1st,3rd,7th day postoperatively respectively,and the level of resting energy expenditure(REE) was also measured in the morning. Furthermore,insulin resistance index was calculated,and the related factors were analysed by Bivariate Correlation Method,and the lengh of hospital stay and postoperative complications etc were recorded respectively.Results The levels of FBG(t=5.709,P＜0.01),FINS(t=2.186,P＜0.05),lnHOMA-IR(t=3.025,P＜0.01) and the incidence rate of insuline resistance(IR) were decreased significantly in the patients in intensive group. The postoperative REE(t=2.521,P＜0.05) and CRP(t=2.550,P＜0.05) of patients in intensive insulin therapy group were remarkably lower than those in control one.The levels of prealbumin(PRE),transferrin(TRF), retinal-binding protein(RbP) in the intensive insulin therapy patients were improved more significantly than those in control group after operation respectively(t=2.649,2.799,2.192,P＜0.05).The body mass index(BMI) and fasting serum insulin level were highly positively correlated with the index of insulin resistance(r=0.739,0.929,P＜0.01).The duration of fever, antibiotic use,passage of gas by anus(t=2.798,2.598,2.879,P＜0.05) and the lengh of hospital stay(P＜0.05),the occurance of postoperative complications(t=2.388,P＜0.05) were also significantly lower than those in control group.Conclusions Compared with routine therapy,the intensive insulin therapy can decrease the insulin resistance,reduce patient's REE and inflammatory reaction,improve the status of nutrition and prevent postoperative complications after radical gastrectomy.BMI is a simple, economic and convenient index to estimate the incidence rate of IR.