Effect of perioperative oral carbohydrate therapy on postoperative insulin resistance in patients undergoing gynecological laparoscopic surgery

Abstract

Objective To observe the effect of perioperative oral carbohydrate therapy and traditional diet regimen on insulin resistance (IR) in patients undergoing gynecological laparoscopic surgery. Methods A total of 98 non-diabetic patients admitted to the Department of Gynaecology, Affiliated Hospital of Xuzhou Medical University from February to August 2018 were selected for laparoscopic total hysterectomy. The patients receiving perioperative oral carbohydrate therapy were selected as an observation group (50 cases), and those receiving traditional diet regimen were included as a control group (48 cases). Fasting plasma glucose (FPG) and fasting insulin (FINS) before surgery and 1 and 3 days after surgery were detected in all cases, and the homeostasis model insulin resistance index (HOME-IR) was calculated by the homeostasis model evaluation method. The independent sample t-test was used to compare the parameters such as FPG, FINS, and HOME-IR between the two groups. The exact probability method was used to compare the incidence of abdominal distension, postoperative ventilation, and postoperative fever in the two groups. Results There was no statistically significant difference in FPG between the observation group and the control group before and on the first day after surgery (P>0.05), while FPG was significantly reduced on the third day after surgery [(4.34±0.59) mmol/L vs (4.96±0.64) mmol/L, t=-4.96, P=0.002]. There was no significant difference in FINS (P>0.05) between the observation group and the control group before and on the first day after surgery, while the FINS [(45.39±13.55) mIU/L vs (51.18±9.34) mIU/L] on the third day after the operation was significantly reduced (t=-2.46, P=0.033). There was no statistically significant difference in HOME-IR between the observation group and the control group (P>0.05) before operation, but HOME-IR was significantly reduced on the first and third day after operation [(13.08±4.80) vs (15.03±4.11); (9.37±3.65) vs (11.30±2.55), t=-0.69, P=0.042; t=-3.99, P=0.033]. The ventilation rate of the observation group at 24 h after the operation was significantly increased compared with the control group (76.0% vs 64.6%, P=0.045). There was no significant difference in the incidence of postoperative abdominal distension or postoperative fever between the two groups (P>0.05). No intraoperative aspiration occurred in either group. Conclusion Compared with traditional dietary restriction, oral carbohydrate therapy during the perioperative period of gynecological laparoscopic surgery can effectively reduce the degree of IR after surgery and promote the postoperative rehabilitation, without increasing the incidence of perioperative complications. Key words: Perioperative; Insulin resistance; Accelerated rehabilitation surgery