A Research In The Effect On Insulin Resistance In The Perioperative Period Of Surgical Operations With Different Trauma

IntroductionThe insulin resistance means the biology effect produced by one fixed amount of insulin is lower than the anticipated level, which causes the sensitivity and reaction of outside butt organization (mainly skeleton muscle, liver and fat organization) to the inside source or the outside source insulin to become lower, and causes the insulin measuring for physiology to produce lower physiology effect than normal. This is a kind of abnormal pathologic physiology appearance, and is the common dangerous factor among many clinical diseases, which has become a hot issue of research interested by many academics in medical field in recent years.The insulin resistance after wound is very widespread. The states under stimulation such as serious infection, wound, surgical operation, etc. usually bring strong incitement to the organic body, causing hormone under stimulation to release in great quantities and the organization's sensitivity to the insulin to lower via the variety of nerve endocrine, causing the mess of sugar metabolism, and leading to a high blood sugar disease, high insulin blood disease, high blood fat disease, etc. Plasma glucose's going up, as the organic body's reaction of protection to wound, can guarantee the plasma glucose supply for brain cell, red cell, etc. to maintain the normal cell function. But continuous increase in the plasma glucose usually produces bad results, which is mainly presented by the toxicity function that the overloads of sugar inside the cell play in non- insulin's dependence on the cell. Normally these cells with high plasma glucose can automatically descend absorbing plasma glucose, prevent the sugar density inside the cell from being too high, and thus protect the cell function. In the surgical operation under stimulation and anoxia, some cell factors can make the cell lose this kind of function. The overloads of sugar inside the cell cause obvious increase in oxidized metabolism outcome created by the line granule body, which to certain degree will influence the expression of particular gene and create cell toxicity function.During the round surgical operation period, a chain of stimulation factors such as patients' mental fear, anaesthetizing, surgical operation, blood loss, etc. usually result in strong stimulation to the organic body, making the metabolism of insulin holdout hormone like adrenaline and pancreas high blood sugar inside the body increase, causing the sugar to lower, glucose exploitation in the outside organizations to decrease, but theβcell secretion and the liver sugar output to promote. This will lead to the appearance of both high blood sugar disease and high insulin blood disease, making the insulin sensitivity of organizations lower, then causing the mess of the sugar fat metabolism, breaking the stability of the environment inside the organic body, making the ability of the organic body in anti-infect and anti-shock obviously drop, and having bad effects on patients' recover from the operation.Therefore, inquiry into the outbreak mechanism of insulin resistance caused by trauma has great significance in adopting valid measures and improving patients' metabolism condition.through observing the variety of plasma insulin sensitivity index before perianaesthesia, after operation, one day after operation and three days after operation, the research studies the relationship between the degree of insulin resistance in the round surgical operation period and that of surgical operation wound, providing the theoretical basis for the adoption of a suitable processing in the clinical round surgical operation period to lower or shorten IR time after operation. ObjectiveThough observing the variety of insulin sensitivity index before perianaesthesia and after operation, the research studies the relationship between the degree of insulin holdout and that of surgical operation wound in the round surgical operation period.Materials and Methods1. General Data60 samples who have complete data of medical history and have general and gynecology belly all numb surgical operation by selecting dates without history of diabetes, ASA I～II, whose ages are 18～80 years old with normal body temperatures, the weight is 50～85 kg (the request for the scope of whose weight is≤20% of the standard weight), who are not obviously excrescent in various normal tests and checks before operation, who don't have diseases in heart, lung, liver, kidney and the system of the nerve muscle, and who have no mess in sour-alkali balance and water electrolyte. Grading all cases according to POSSUM, record physiology (including 12 physiology indexes), and the trauma degree of surgical operation (including 6 indexes: the size of the surgical operation, the number of surgical operations, the total amount of blood loss, the degree of the belly cavity pollution, malignant tumor, and the category of surgical operations). Grading upon the trauma degree of surgical operation can be divided into 3 groups, Set I: the trauma degree of surgical operation is≤7 points; Set II :the encroaching degree of surgical operation is 8～10 points; and Set III: the trauma degree of surgical operation is >10 points.2. The agentia and equipmentIn addition to regular drugs and device of anaesthesia, others are required: Siemens ADVIA Centaur full-automatic chemical light analysis instrument (Germany)Ri Li 7170A full-automatic bio-chemical analysis instrument (Japan)Zhong Jia KDC-40 centrifugal machine with low speeds (Zhong Jia branch company of Ke Da Creation corp)3. Anaesthesia MethodAll the patients have no use of medicine before operation. Intravenous injection of midazolam 5 mg, fentanyl 5μg/kg, propofol 2～2.5 mg/kg, and vecuronium 0.1 mg/kg, to carry on anaesthesia inducement. Mechanical ventilation was started after trachea intubation, with breathing frequency 10～14 times/min, and the dampness amount 8～10 ml/kg, maintaining EtCO₂ within 30～45 mmHg. Interval injection of fentanyl and vecuronium to maintain the stability of anaesthesia.4. Monitoring MethodThe anaesthesia machine chooses to use Datex-Ohmeda S/5 Aespires (containing ISO), and apply Datex-Ohmeda S/5 CAM tightly packed type of anaesthesia guardianship instrument to monitor the noninvasive BP, ECG, and SpO₂, recording the index of the blood dynamic mechanics, including constringency, stretching press, the average artery press, CO₂ consistency (EtCO₂) at the end of breathing, and anaesthesia medicine consistency (MAC) at the end of breathing.5. Specimen CollectionRespectively before anaesthetizing inducement (To) , after pulling out windpipe pipe when the surgical operation is over (T₁), the first morning after operation with an empty stomach (T2), and the third morning after operation (T3), 5 ml of outside vein blood is collected and put into the tube respectively (BD Vacutainer SST II), carrying on an examination in blood plasma glucose and insulin.6. Specimen Examination(1) Blood plasma glucose examination:Using method of Hexokinase to measure blood plasma glucose: 2.5 ml of vein blood is placed in a vacuum centrifugal tube. Being centrifugal at low speed (3500 turns/min) 5 min, serum is taken at the upper level, and placed in a sharp ended plastic tube for an automatic examination within 6～8 hours. The model of the instrument: Ri Li 7170A full-automatic bio-chemical analysis instrument. The try box: produced by Yi Jie Company in France, the passing number: 070102, and the normal referential scope: 4.0～6.38 mmol/L.(2) Blood plasma insulin examination:Using the method of chemiluminescence to examine blood plasma insulin: 5 ml of vein blood is placed in a vacuum centrifugal tube for 37℃water bath, and a 10 minute warm cultivation, serum is separated through a centrifugal method (3500 turns/min) 5 min, and is taken to be placed in a sharp ended plastic tube for an automatic examination. The model of the instrument: Siemens ADVIA Centaur full-automatic chemical light analysis instrument. Making reference to a value: 3.0～23.0 mU/L.7. Statistics AnalysisStatistics analysis is made by using SPSS13.0 software packages. Calculating dataare presented with (X|-)±S, counting data are examined by X², and the comparisonbetween various samples of different sets is examined by square difference analysis and non-parameter (K-W). P<0.05 means the difference has statistic meaning.ResultThe result shows that the difference between different grading sets of surgical operation trauma degree (I, II and III sets) in age, sex, POSSUM physiology grading and BMI has no statistic meaning (P>0.05). It can be seen from the statistic result that, 24h after surgical operation, set II averagely descends by 26.82% inΔISI, set III averagely descends by up to 39.46%, but set I descends only by 15.07%, and the difference between sets has statistic meaning (P<0.05).ConclusionThe insulin resistance (IR) presents a positive relation with the surgical operation degree. In other words, the severer the wound is, the bigger IR is. It can be seen that IR exists just when the surgical operation is over, it reaches the peak about 24h after operation, and it will descend gradually with the recover of patients. But the severer the surgical operation wound is, the longer IR will continue.