The Effect Of Preoperative Enteral Nutrition On The Postoperative Insulin Resistance

Surgical procedure is a double blade sword. It not only removes the focus of disease, but also brings about the side effect of body. Trauma will make the strong, sometimes, permanent injury to the body. So, operative trauma is still the hidden danger for the patients' recovery. During the operation, the stimulation, such as anesthesia, operation, blood loss... would make the strong stress on the body. It will lead to the release of stress hormones and insulin resistance. Thereafter cause the disorders of glucose and fat metabolism, destroy the body balance in vivo. It makes the bad effect on the patients' postoperative recovery and prognosis. If we can lower the insulin resistance, it will be good for the patients' recovery.Overnight fasting as a preoperative routine has more than 100 years. Its' main purpose is to lower the risk of aspiration. But this point is in doubt now. Preoperative fasting exhausted the hepatic glycogen, dropped liver and intestinal functions. Animal experiment demonstrated the degree of hepatic glycogen was associated with the rate of death animal. Even if the short time of fasting, it will not be the ideal background for the patients prepared for the operation. In order to study the possibility of preoperative enteral nutrition and the effect of enteral nutrition on the postoperativeinsulin resistance, we designed this study.This study includes two sections: Section one, to measure the gastric emptying of Fresubin (the name of enteral nutrition) by gastroscopy; Section two, to study the effect of preoperative nutrition on the postoperative insulin resistance.Section one: To measure the gastric emptying of Fresubin (the name of enteral nutrition) by gastroscopyMaterial and Methodss5 routine fasting patients, aged from 20 to 58ys, with the average of 42.4ys who would undergo physical examination in out-patient department and fulfill the following criteria were studied: not taking medication known to affect intermediary metabolism or gastric emptying; no symptoms or signs of metabolic, hepatic, renal, or gastric disease. 15 3h fasting patients, aged from 31 to 65 ys, with the average of 47.4ys who would undergo LC in in-patient department were studied, the excluding criteria was as the above. The treatment policy was: 15 routine fasting patients were fasted after dinner night before the endoscopies were performed. 15 3h fasting patients were fasted after dinner, but at 5 am before endoscopies examination, they would drink 500ml fresubin in three minutes.(white, milky fluid, total calorie 500kcal,19gs of protein,17gs of fat,69gs of carbohydrate, and kinds of vitamins and mineral elements.) All patients were performed endoscopies examination at Sam. Gastric fluids were collected. The volume and PH value of gastric fluids were measured.Statistics analysis: All data was processed with SPSS 11.0 software bag on personal computer. Enumeration data was checked by t Test.ResultIn routine fasting group, the average fasting time was 13.83h, the average volume of gastric fluid was 35.47 13.04mL , the average PH value of gastric fluid was 2.22 1.13, In 3h fasting group, the average fasting time was 3.57h, the average volume of gastric fluid was 42.75 21.52mL, the average PH value of gastric fluid was 3.30 1.03. There was no significant difference between two groups.Conclusion1. Overnight fast was not necessary for patients who would undergo selective operation.2. The volume of gastric fluid was not increased significantly when 500mL of Fresubin were given 3h before selective operation.