Effect Of Intensive Insulin Therapy On Resting Energy Expenditure In Postoperative Patients Underwent Radical Distal Gastrectomy

Objective:To investigate the effect of intensive versus less intensive insulin therapy on resting energy expenditure in postoperative patients undergoing radical distal gastrectomy.Methods:Within 24 h of ICU administration.64 patients of gastric cancer in the middle or lower part of stomach were enrolled after written informed consent and randomized to intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or less intensive insulin therapy group to keep levels less than 10mmol/L. Resting energy expenditure(REE), Respiratory quotient(RQ), Resting energy expenditure per kilogram(REE/kg) and lipid oxidation ratio were monitored by indirect energy metabolic system on preoperative and postoperative 1st,3r and 7TH day; Fasting blood glucose and insulin concentration were measured for HOMA-IR assessment.Results:1). Comparing with preoperative baseline, postoperative REE increased by over 22.15% and 11.07%;REE/kg rose up to 27.22±1.33 kcal/kg and 24.72±1.43 kcal/kg; RQ decreased to 0.759±0.034 and 0.791±0.037:lipids oxidation ratio was up to (78.25±17.74)% and (67.13±12.76)% more than 50% supported by parenteral nutrition or (37.56±11.64)% at the baseline; the level of Ln-HOMA-IR went up dramatically (P＜0.05. respectively) on postoperative 1st and 3rd day. Meanwhile the concentration of total protein, albumin, triglyceride and total Cholesterol decline significantly on postoperative 1st and 3rd day comparing with pre-operation levels (P＜0.05, respectively).2). Comparing with less intensive insulin therapy group.ⅡT reduced the REE/kg level (27.22±1.33 vs 29.97±1.47 kcal/kg, P=0.008:24.72±1.43 vs 25.66±1.63 kcal/kg, P=0.013); and decreased the Ln-HOMA-IR score (P=0.019 and 0.028) on postoperative 1st and 3rd day; IIT can decreased obviously the level of CRP on postoperative 1st and 3rd day (P-0.017,0.006): the total proteins and albumin concentration in IIT group were more than its levels in less intensive insulin therapy(P=0.023.0.009).3). There were no difference in postoperative RQ and LOR levels between two groups, meanwhile the patients in IIT group were supported with 567.12±11.55 kcal in operationg day and 1187±59 kcal during postoperative 1st and 3rd, not different from less intensive insulin therapy group (P=0.624); which were lower than REE on postoperative 1st and 3rd day.Conclusions:1). There were a hypermetabolic state of energy expenditure, katabolic metabolism and insulin resistance in the postoperative patients undergoing the radical distal gastrectomy. 2). There were some benefits of IIT in reducing mean energy expenditure and the consumption of protein, decreasing perioperative IR level in this small population undergoing the radical distal gastrectomy.3). There were no befefits of IIT in increasing the RQ and decreasing LOR which was related with that energy supply was lower than energy expenditure.