Effects Of 5% Glucose-Insulin Solution On Metabolism Disorder And Insulin Resistance Induced By Surgical Stress

ObjectiveThe purpose of this study was to investigate the improve effect of 5% glucose-insulin solution on metabolism disorder and insulin resistance induced by surgical stress. MethodsOur study groups consisted of twenty patients aged from 20 to 46 years, weighted from 51 to 78 Kg and ASA was â…  to â…¡. Patients with a personal or family history of cardiopathy, hypertension, hyperlipemia and diabetes mellitus or metabolic diseases were excluded.All patients were not taking medication known to affect glucose metabolism.The patients were randomized to two groups:control group( â…  ,n=10) and 5% glucose-insulin solution group (â…¡,n=10).In group â…¡,5% glucose(0.25g · Kg^-1 · h^-1) and insulin (glucose:insulin=5:1) was infused in one hour before operation.All patients were anesthesized by general anesthesia.General anesthesia was induced with midazolam 0.05mg/kg,propofol 1 1 5mg·kg^-1,fentany 4μg·Kg^-1, and vecuronium 0.1 0.15mg· kg^-1.The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained by continuous infusion of propofol(4⁶mg·Kg^-1· h^-1) and supplemented with vecuronium and fentany in general bolues.Blood samples were obtained respectively at the followingintervals:before solution infusion (preinfusion TO), after infusion before operation(preoperation,T 1), lh after operation begin (perioperation, T2), and 10 min after extubation(postoperation, T3). Serum glucose(FPG),insulin(FINS),C-peptide(CP) and cortisol in the samples were measured. All values were means ± SE,q-test and t-test were used in statistics.Statistical significance was accepted at P<0.05. ResultsPerioperation and postoperation,the levels of serum glucose and cortisol were significantly higher than the levels preinfusion in group I ,whereas no significant chang was found in group II .And there was significant difference between the control group and 5% glucose-insulin group .Insulin and C-peptide levels did not chang during and after operation compared with preinfusion and preoperation in group I .But in group II ,the levels of insulin and C-peptide during and after operation were significantly higher than the levels preinfusion. ConclusionThe mechanisms of insulin resistance(IR) induced by surgery stress is very complicate,and not clear by now.It is well known that IR developes in all types of surgical sress.Previous studies indicate that the peripheral insulin resistance develops after trauma may be due to the increased stress hormones,the decreased insulin receptors and the postreceptor defect.IR may be a mechanism of protect to the whole body.It reduces glucose disposal and utilization in peripheral tissues and muscles, so brain can obtain enough glucose .But a severe IR is not beneficial for body.From the present investigation ,we conclude that it is possible to keep important aspects of metabolism completely normal after surgery by changing the metabolic profile with 5% glucose and insulinsolution infusions started one hour before operation.Stress hormonal responses,glucose metabolism, the secretion of pancreatic 3 cells and insulin sensitivity are improved and the degrees of surgery stress and IR are reduced by glucose-insulin solution infusion.