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Intra-operative administration of low-dose IV glucose attenuates post-operative insulin resistance.

Abstract：

BACKGROUND & AIMS:Insulin sensitivity often decreases after surgery in spite of normal insulin secretion, and may worsen the outcome. This post-operative insulin resistance increases according to the magnitude of surgical invasion. However, supplementation of carbohydrates before surgery attenuates the post-operative insulin resistance. This study aimed to investigate the effect of intra-operative administration of low-dose glucose on the post-operative insulin resistance. METHODS:Patients undergoing maxillofacial surgery were randomly assigned to two groups throughout the surgical procedure: The glucose group receiving acetated Ringer solution with 1.5% glucose and the control group receiving acetated Ringer solution without glucose. Insulin resistance quantified by the mean glucose infusion rate (the glucose infusion rate) was evaluated by glucose clamp using the STG-22TM instrument on the previous day and on the next day of surgery. Blood glucose level was monitored continuously during surgery. In addition, serum insulin, ketone bodies and 3-methylhistidine were measured during perioperative period. RESULTS:Patients in the glucose group (n=11) received 0.15 ± 0.06 g/kg/h of glucose during surgery, while patients in the control group (n=11) received no glucose. In both groups, however, the mean blood glucose levels were maintained stable at less than 150 mg/dL during and after surgery. The serum ketone bodies significantly increased after surgery in the control group (p=0.0035), while it decreased significantly in the glucose group (p=0.043). The reduction rate in the glucose infusion rate was significantly lower in the glucose group, 43.3 ± 20.7%, than that in the control group, 57.7 ± 9.3% (p=0.041). CONCLUSIONS:Intra-operative small-dose of glucose administration may suppress ketogenesis and attenuate the post-operative insulin resistance without causing hyperglycemia. :背景与目的：手术后尽管胰岛素分泌正常，但胰岛素的敏感性往往会降低，这可能会使预后不良。手术后胰岛素抵抗的增加跟手术侵害的程度有关。然而，手术前碳水化合物的补充减弱了手术后胰岛素的抵抗。本研究旨在探讨术中给予低剂量葡萄糖对术后胰岛素抵抗的影响。方法：接受颌面手术的患者根据手术程序被随机分为两个组。葡萄糖组接受含1.5%葡萄糖的醋酸格林溶液，对照组接受不含葡萄糖的醋酸格林溶液。用平均的葡萄糖输注率来量化胰岛素抵抗，分别在手术前一天和手术后第二天用STG-22TM仪器根据葡萄糖钳夹来估计葡萄糖输注率。手术中连续监测血糖水平。另外，围手术期测量血清胰岛素、酮体和3-甲基组氨酸的变化。结果：葡萄糖组患者（11人）在手术中输入葡萄糖0.15±0.06 g/kg/h，对照组患者（11人）没有输入葡萄糖。然而，两组在手术中和手术后血糖平均水平均稳定在低于150 mg/dL。手术后，对照组的血清酮体显著增加（p=0.0035），而葡萄糖组血清酮体显著降低（p=0.043）。葡萄糖组的葡萄糖输注率的降低率（43.320.7%）显著低于对照组（57.79.3%）（p=0.041）。结论：术中小剂量给予葡萄糖能够抑制生酮作用和减轻手术后胰岛素抵抗，而不会导致高血糖症。

journal_name

Asia Pac J Clin Nutr

journal_title

Asia Pacific journal of clinical nutrition

authors

Fujino H,Itoda S,Esaki K,Tsukamoto M,Sako S,Matsuo K,Sakamoto E,Suwa K,Yokoyama T

doi

10.6133/apjcn.2014.23.3.10

subject

Has Abstract

pub_date

2014-01-01 00:00:00

pages

400-7

issue

eissn

0964-7058

issn

1440-6047

journal_volume

pub_type

杂志文章,随机对照试验

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Intra-operative administration of low-dose IV glucose attenuates post-operative insulin resistance.