国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2011年
1期
32-35,112
,共5页
刘伟%苏跃%田鸣%耿万明%张宗德
劉偉%囌躍%田鳴%耿萬明%張宗德
류위%소약%전명%경만명%장종덕
全身麻醉%硬膜外%胸外科手术%胰岛素抵抗%超敏C反应蛋白%白细胞介素-6%抵抗素
全身痳醉%硬膜外%胸外科手術%胰島素牴抗%超敏C反應蛋白%白細胞介素-6%牴抗素
전신마취%경막외%흉외과수술%이도소저항%초민C반응단백%백세포개소-6%저항소
General anesthesia%Epidural analgesia%Thoracic surgery%Insulin resistance%Hypersensitivity C-reactive protein%Interleukin-6%Resistin
目的 研究不同麻醉和术后镇痛方式对胸科手术后胰岛素抵抗(insulin resistance,IR)的影响及相关因素.方法 60例胸科手术患者按随机数字表法随机分为两组:对照组(GA组,n=30),实验组(GEA组,n=30).GA组行全麻+术后静脉镇痛;GEA组行硬膜外麻醉复合全麻+术后硬膜外镇痛.分别于麻醉前、术毕拔除气管导管后和术后1 d晨测定血浆超敏C反应蛋白(hypersensitivity C-reactive protein,HCRP)、血糖(blood glucose,FPG)、白介素6(interleukin-6,IL-6)、抵抗素(resistin,RESIS)、胰岛素(ins ulin,FINS)的浓度和计算稳态模式评估法(hemeostasis model assessment,HOMA)值.术后2、6、10 h和术后1 dVAS评分评估疼痛.结果 两组HCRP、IL-6在术后1 d时,与麻醉前和术毕分别比较差异均有统计学意义(P＜0.01).两组FINS在术后1 d时分别与术毕比较差异均有统计学意义(P＜0.01),GA组从(20±10)mU/L升高到(30±12)mU/L;GEA组从(18±7)mU/L升高到(26±10)mU/L.两组FPG在术毕和术后1 d时分别与麻醉前比较差异均有统计学意义(P＜0.01);术毕和术后1 d时GEA组与GA组比较差异均有统计学意义(P＜0.05),分别为术毕(6.4±1.4)mmol/L、(7.3±1.5)mmo1/L和术后1 d(6.4±1.2)mmol/L、(7.2±1.1)mmol/L.两组HOMA值术后1 d与麻醉前和术毕分别比较差异均有统计学意义(P＜0.01);HOMA值在术后1 d时,GEA组与GA组比较差异均有统计学意义(P＜0.05,为2.0±1.1、2.3±1.6.两组RESIS和VAS相比差异均无统计学意义.术毕时HOMA值与RESIS和HCRP呈正相关(r=0.61),术后1 d时HOMA值与RESIS和IL-6呈正相关(r=0.51).结论 采用HOMA表明:①胸科手术应用全麻复合硬膜外麻醉和镇痛,术后1 d提示可降低IR.②术毕HOMA值与术毕时的RESIS和HCRP呈正相关,术后1 d HOMA值与术后1 d时的RESIS和IL-6呈正相关.
目的 研究不同痳醉和術後鎮痛方式對胸科手術後胰島素牴抗(insulin resistance,IR)的影響及相關因素.方法 60例胸科手術患者按隨機數字錶法隨機分為兩組:對照組(GA組,n=30),實驗組(GEA組,n=30).GA組行全痳+術後靜脈鎮痛;GEA組行硬膜外痳醉複閤全痳+術後硬膜外鎮痛.分彆于痳醉前、術畢拔除氣管導管後和術後1 d晨測定血漿超敏C反應蛋白(hypersensitivity C-reactive protein,HCRP)、血糖(blood glucose,FPG)、白介素6(interleukin-6,IL-6)、牴抗素(resistin,RESIS)、胰島素(ins ulin,FINS)的濃度和計算穩態模式評估法(hemeostasis model assessment,HOMA)值.術後2、6、10 h和術後1 dVAS評分評估疼痛.結果 兩組HCRP、IL-6在術後1 d時,與痳醉前和術畢分彆比較差異均有統計學意義(P＜0.01).兩組FINS在術後1 d時分彆與術畢比較差異均有統計學意義(P＜0.01),GA組從(20±10)mU/L升高到(30±12)mU/L;GEA組從(18±7)mU/L升高到(26±10)mU/L.兩組FPG在術畢和術後1 d時分彆與痳醉前比較差異均有統計學意義(P＜0.01);術畢和術後1 d時GEA組與GA組比較差異均有統計學意義(P＜0.05),分彆為術畢(6.4±1.4)mmol/L、(7.3±1.5)mmo1/L和術後1 d(6.4±1.2)mmol/L、(7.2±1.1)mmol/L.兩組HOMA值術後1 d與痳醉前和術畢分彆比較差異均有統計學意義(P＜0.01);HOMA值在術後1 d時,GEA組與GA組比較差異均有統計學意義(P＜0.05,為2.0±1.1、2.3±1.6.兩組RESIS和VAS相比差異均無統計學意義.術畢時HOMA值與RESIS和HCRP呈正相關(r=0.61),術後1 d時HOMA值與RESIS和IL-6呈正相關(r=0.51).結論 採用HOMA錶明:①胸科手術應用全痳複閤硬膜外痳醉和鎮痛,術後1 d提示可降低IR.②術畢HOMA值與術畢時的RESIS和HCRP呈正相關,術後1 d HOMA值與術後1 d時的RESIS和IL-6呈正相關.
목적 연구불동마취화술후진통방식대흉과수술후이도소저항(insulin resistance,IR)적영향급상관인소.방법 60례흉과수술환자안수궤수자표법수궤분위량조:대조조(GA조,n=30),실험조(GEA조,n=30).GA조행전마+술후정맥진통;GEA조행경막외마취복합전마+술후경막외진통.분별우마취전、술필발제기관도관후화술후1 d신측정혈장초민C반응단백(hypersensitivity C-reactive protein,HCRP)、혈당(blood glucose,FPG)、백개소6(interleukin-6,IL-6)、저항소(resistin,RESIS)、이도소(ins ulin,FINS)적농도화계산은태모식평고법(hemeostasis model assessment,HOMA)치.술후2、6、10 h화술후1 dVAS평분평고동통.결과 량조HCRP、IL-6재술후1 d시,여마취전화술필분별비교차이균유통계학의의(P＜0.01).량조FINS재술후1 d시분별여술필비교차이균유통계학의의(P＜0.01),GA조종(20±10)mU/L승고도(30±12)mU/L;GEA조종(18±7)mU/L승고도(26±10)mU/L.량조FPG재술필화술후1 d시분별여마취전비교차이균유통계학의의(P＜0.01);술필화술후1 d시GEA조여GA조비교차이균유통계학의의(P＜0.05),분별위술필(6.4±1.4)mmol/L、(7.3±1.5)mmo1/L화술후1 d(6.4±1.2)mmol/L、(7.2±1.1)mmol/L.량조HOMA치술후1 d여마취전화술필분별비교차이균유통계학의의(P＜0.01);HOMA치재술후1 d시,GEA조여GA조비교차이균유통계학의의(P＜0.05,위2.0±1.1、2.3±1.6.량조RESIS화VAS상비차이균무통계학의의.술필시HOMA치여RESIS화HCRP정정상관(r=0.61),술후1 d시HOMA치여RESIS화IL-6정정상관(r=0.51).결론 채용HOMA표명:①흉과수술응용전마복합경막외마취화진통,술후1 d제시가강저IR.②술필HOMA치여술필시적RESIS화HCRP정정상관,술후1 d HOMA치여술후1 d시적RESIS화IL-6정정상관.
Objective To investigate insulin resistance (IR) to thoracic surgery with different anesthesia and analgesia and effects on correlative factors.Methods 60 ASA Ⅰ- Ⅱ patients undergoing thoracic surgery were randomized to receive either general anesthesia and PCIG (GA,n=30)or general anesthesia combined with epidural anesthesia and PCEA (GEA,n=30). Peripheral venous blood samples were taken before induction of anesthesia,at the end of surgery and on themorning of postoperative day 1,for detecting plasma hypersensitivity C-reactive protein (HCRP),blood glucose (FPG),interleukin-6 (IL-6),resistin (RESIS) and insulin (FINS). Postoperative pain was assessed by VAS at the following time points:2 h,6 h,10 h after operation and on the morning of postoperative day 1. And insulin resistance was assessed by Hemeostasis Model Assessment (HOMA). The correlation between HOMA and concentration of HCRP,IL-6 and RESIS was analysised at the end of surgery and on the morning of postoperative day 1.Results There were no significant differences in age,sex ratio,BMI,and operative duration between both groups. HCRP and IL-6 significantly increased on the morning of postoperative day 1 comparing with before induction of anesthesia and the end of surgery in both groups respectively (P＜0.01). FINS significantly increased on the morning of postoperative day 1comparing with the end of surgery in both groups respectively (P＜0.01). GA:from (20±10) mU/L to(30±12) mU/L;GEA:from (18±7) mU/L to (26±10) mU/L. FPG significantly increased at the end of surgery and on the morning of postoperative day 1 in both groups respectively (P＜0.01),compared with before induction of anesthesia. In the GEA,FPG significantly decreased at the end of surgery (6.4±1.4) mmol/L and on the morning of postoperative day 1 (6.4±1.2) mmol/L respectively (P＜0.05). Compared with before induction of anesthesia and the end of surgery,HOMA significantly increased on the morning of postoperative day 1 in both groups respectively (P＜0.01). In GEA group (2.3±l.6),HOMA significantly decreased (2.0±1.1)on the morning of postoperative day 1(P＜0.05). In both groups,there was no significant change on RESIS and VAS. There were significant positive correlation between HOMA and concentration of HCRP and RESIS at the end of surgery (r=0.61). While there were significiant positive correlation between HOMA and concentration of IL-6 and RESIS on the morning of postoperative day 1 (r=0.51).Conclusion Hemeostasis Model Assessment showed that ① Insulin resistance decreased on the morning of postoperative day 1 with general anesthesia combined with epidural anesthesia and PCEA . ②There were significant positive correlation between HOMA and concentration of HCRP and RESIS at the end of surgery. And there were significiant positive correlation between HOMA and concentration of IL-6 and RESIS on the morning of postoperative day 1.
