Effects Of Vitamin-rich Carbohydrate Loading Before Surgery On The Incidence Of Postoperative Delirium In Patients Undergoing Laparoscopic Radical Resection Of Colorectal Cancer

Background:Delirium is a mysterious clinical syndrome characterized by a disorder of the basic cognitive and attention functions of the brain.It often occurs in older adults,especially if neurocognitive impairment is preexisting and is accompanied by complications such as infection or trauma.With the aging of the population,the incidence of surgery and anesthesia in elderly patients has increased significantly,and postoperative delirium has become an increasingly serious public health problem.The emergence of rapid rehabilitation surgery shortened the length of stay,reduced the total cost of stay and improved the quality of life of patients.The ERAS scheme has been widely used in various surgical disciplines in the world.Preoperative carbohydrate load is an important component of accelerated rehabilitation surgery,and whether it has a positive effect on postoperative delirium is a hot topic of current research,but still controversial.Objective: The primary objective of this study was to investigate whether preoperative vitamin-rich carbohydrate loading could reduce the incidence of postoperative delirium in patients undergoing laparoscopic radical resection of colorectal cancer.The secondary objective was to investigate whether preoperative vitamin-rich carbohydrate could improve postoperative insulin resistance,reduce hospital day and relieve other perioperative discomfort such as dry mouth,hunger,nausea,and pain.Method: This study is a prospective randomized controlled trial.160 elderly patients who planned to undergo laparoscopic radical resection of colorectal cancer under general anesthesia during elective surgery in the department of anesthesiology of our hospital from August 2018 to December 2019 were selected as subjects.Group A was randomly divided into group A: vitamin rich carbohydrate load group before surgery and group B: fasting and non-drinking group before surgery.RASS sedation assessment form and fuzzy consciousness assessment method(CAM scale)were used to determine the occurrence of postoperative delirium,and the incidence of delirium within 5 days after the operation was collected and recorded.Meanwhile,blood glucose was measured at three time points before anesthesia,6 hours after surgery and the morning of the third day after surgery,and venous blood 5ml was collected in the EDTA anticoagulant tube.Insulin concentration in the serum at the above time points was detected,and insulin resistance index was calculated by homa.ir method.Visual analogue scale(VAS scale 0-10)was used to score subjective discomfort during perioperative period,which mainly included thirst,hunger,nausea and pain.The time points of evaluation were repeated before entering the operating room(T1)and after operation 4(T2),8(T3),12(T4)and 24(T5)h.Result:Among the 156 cases analyzed,the demographic data of the vitamin-rich carbohydrate load group and the fasting and no-drink group were similar,and the MMSE score,CRP,HGB,WBC,type of surgery,duration of anesthesia,duration of surgery,blood loss and length of hospitalization in the two groups showed no significant difference(P >0.05).The points difference analysis of repeated measurement analysis the difference between different time points after CAM,the results show that the mutual interactions between time and group(F = 86.22,P <0.05),compared with A group,Bgroup,the incidence of postoperative delirium 1-4days significantly lower,and the difference was statistically significant(P < 0.001),while the fifth day after surgery no difference between the two groups the incidence of postoperative delirium,and there was no statistically significant difference(P >0.05);Two groups of patients with preoperative blood glucose,fasting insulin and insulin resistance index difference had no statistical significance(P > 0.05),and after6 hours,after three days of A group blood glucose,fasting insulin and insulin resistance index were less than B group,and the difference was statistically significant(P<0.000;P<0.000;P<0.000);VAS scores of thirst and hunger in the fasting and no-drink group were significantly higher than those in A group,and the difference was statistically significant(P < 0.05).VAS pain score showed no statistically significant difference between the two groups(P >,0.05).The incidence of nausea and vomiting and the number of antiemesis requirements were significantly higher in the B group,and the difference was statistically significant(P < 0.05).Conclusion:Preoperative carbohydrate load rich in vitamins can significantly improve postoperative delirium in patients undergoing laparoscopic radical resection of colorectal cancer,reduce insulin resistance caused by surgery and reduce perioperative discomfort,such as thirst,hunger,nausea and vomiting,but have no significant effect on postoperative pain and hospital day.