| BackgroudNowadays the main treatment for patients with gastrointestinal tumor is surgical excision.But as a traumatic treatment, surgical operation is a strong stressor to the patients.It may cause metabolic disorder due to the abnormal physiological functions of insulin, which is called surgical insulin resistance. Hyperglycemia and hyperinsulinemia is the the typical characteristic of surgical insulin resistance.The catabolism of protein and fat may have a close relationship with IR after operation. As the bad effects to the recovery of patients,IR after operation has drawn more and more attention of current medical circles.ObjectivesTo observe the epidemiological features and clinical significance of insulin resistance after operation;To investigate the effect of indomethacin on insulin resistance and metabolic response to surgical injure of patients with gastrointestinal tumor after operation; To investigate the relationship between IR and CRP of patients with gastrointestinal tumor after operation; To investigate the influence of insulin resistance on complications and the days of hospitalization after operation.MethodsFifty-eight patients with gastric cancer or colon cancer were selected randomly to measure body anthropometry and body composition by dual-energy X-ray absorptiometry (DEXA).These fifty-eight cases were divided into indomethacin group and control group.All the operations were performed under general anesthesia and both of the two groups were infused with parenteral nutrition from the first day to the seventh day after operation, whereas the patients in indomethacin group were treated with indomethacin suppository (100mg/12h) in addition. Fasting blood glucose (FBG), insulin (FINS), Cr, BUN, TG, FFA and CRP of the two groups were detected on the day before operation and 24h,72h,120h after operation. Insulin resistance index was calculated by using the homeostasis model assessment (HOMA).Besides, vital signs in 72h,the rate of complications and the days of hospitalization were compared between the two groups after operation.Results(1) At 24h after operation,the incidence of IR was 28.57% in indomethacin group and 56.67% in control group,the total incidence was 43.10%. At 72h after operation,the incidence of IR was 17.86% in indomethacin group and 43.33% in control group,the total incidence was 31.03%. The IR levels of patients in indomethacin group were much more lower than that in control group whether at 24h or 72h. InHOMA-IR was positively correlated with BMI,WHR and body fat.but it was not correlated with age, protein and bone mineral (2)The levels of FBG, FINS and InHOMA-IR of control group on 24h,72h after operation,were obviously higher than that of the indomethacin group and before operation. Both of the two groups,the levels of Cr,BUN,TG and FFA were higher than that befer operation,but tend to be decline after operation.And all the metabolic index were dropped obviously in indomethacin group. No significant difference was found in the levels of CRP between the two groups before and after operation.(3)The vital signs in indomethacin group were more steadily. The rate of complications in indomethacin group (14.29%) wes more lower than that in control group (40%). and the days of hospitalization in control group were longer than that in indomethacin group.Conclusion(1Insulin resistance was widely exised in patients with gastrointestinal tumor. InHOMA-IR was positively correlated with BMI,WHR and body fat.and it was not correlated with age, protein and bone mineral.(2)Indomethacin could reduce the level of insulin resistance, improve glucose metabolism,decrease fat and protein catabolism, decrease morbidity and improve the cure.(3) Indomethacin have no significant influence on the level of CRP. |
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