婴幼儿手术应激后瘦素水平变化的临床研究

目的探讨瘦素水平在婴幼儿大手术应激时的变化及意义。方法选择择期手术患儿17例,分先心组(10例)和非先心组(7例),分别于术前、术中、术后2h、术后24h、术后48h采集外周静脉血,离心后,测定血清中瘦素和皮质醇的水平。结果先心组和非先心组瘦素水平在术中均明显下降(术前分别为3．48±0．23、4．50±0．24．术中为2．12+0．14、3．09±0．21,P＜0．05)。术后24h又恢复至基础水平(3．78±0．19、4．89±0．43．P＞0．05)。皮质醇水平先心组术中显著升高(术前为25．39±1．74,术中为50．87±3．59,P＜0．05),非先心组术中升高(术前为28．61±1．69,术中为31．90±2．02,P＞0．05)；术后24h先心组恢复至基础水平(30．95±1．77,P＞0．05),非先心组水平仍高(37．48±1．92,P＜0．05)。结论在手术应激的早期,瘦素的下降和皮质醇的上升是平行的,瘦素在手术应激早期发挥作用。

The clinical significance of leptin in the postoperative stress response in infants

Objective To investigate the leptin levels and its clinical significance in infants un- dergoing surgery.Methods Seventeen infants were divided into 2 groups:10 with congenital heart defects and 7 with non-congenital heart defects.Peripheral vein blood samples were collected at one day before operation(TO),perioperation(T1),2(T2),24(T3),and 48 hours(T4)after opera- tion.The serum levels of leptin and cortisol were detected and analyzed.Results The serum levels of leptin in both groups were significantly decreased at T1 and T2 compared to those at T0,but all of them recovered to the normal levels at T3.On the contrary,the cortisol levels were significantly in creased in congenital heart defects group at T1 and recovered to the baseline at T3.Meanwhile,the cortisol levels in non-congenital heart defects group were significantly increased at T2 and recovered the baseline at T4.Conclusions Leptin may play a role in the stress response induced by surgery and general anesthesia.The decrease of leptin and the increase of cortisol were paralleled in the early phase of surgical stress response in infants.