Dynamics of leptin, insulin resistance, parathyroid hormone, 25(OH)D in the implementation of the eras-protocol in patients of surgical profile

The aim : to increase the effectiveness of treatment of patients of surgical profile with overweight by developing algorithms for perioperative intensive care for the successful implementation of the ERAS protocol. Material and methods . The basis of this study is the analysis of the results of a comprehensive clinical and instrumental dynamic examination of 122 patients with surgical herniological profile for a period of 1 day to 1 month from the date of surgery. The study included patients with ventral hernias of the anterior abdominal wall, which were determined by the SWR classification. The conditions for admission to the study under the conditions of inclusion were a fence 10 days before surgery to determine the analysis of vitamin D concentration. 3 groups of patients were identified (control, with addition to the protocol of treatment of cholecalciferol, with addition to the protocol of treatment of cholecalciferol and a solution of D-fructose-1,6-diphosphate sodium salt of hydrate). Determined the type of fat distribution, index of visceral obesity, triglycerides, high-density lipoprotein, leptin, fasting glucose, endogenous insulin, calculated the index of HOMA. Parametric statistics methods were used to process the obtained data. Results . In the vast majority of overweight patients (90 %) the abdominal type of fat distribution with the presence of visceral index obesity was determined. At the time of screening, the concentration of leptin in the blood of all studied patients exceeded the upper limit of normal by almost 4 times. The absence of a probable connection between the level of 25 (OH) D and leptin was determined, which confirms the presence of obesity due to reduced muscle mass and impaired energy metabolism, the presence of a relationship between the level of 25 (OH) D, HOMA, concentration of parathyroid hormone in the blood. Conclusions . Implementation of a planned surgical profile in overweight patients at the screening stage 10 days before surgery to determine the level of 25 (OH) D in the blood is a key point in deciding the possibility of conducting the perioperative period according to the ERAS program. Additional purpose to its classical protocol of cholecalciferol and solution of D-fructose-1,6-diphosphate sodium salt of hydrate increases the quality of motor activity of patients after surgery, increases their adaptive potential by restoring lost muscle function. The optimized classical algorithm of the ERAS-program significantly (p <0.05) improved the quality of life in the long term (30 days after surgery), such as physical functioning, general health, viability scale, mental health (SF-36 scale) and decreased body mass index