不同麻醉和镇痛方法对胸科手术胰岛素抵抗及相关因素影响的研究

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...

The investigation of insulin resistance to thoracic surgery with different anesthesia and analgesia and effects on correlative factors

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.