曲马朵对肺叶切除术患者围手术期胰岛素抵抗的影响

探讨静脉注射曲马朵对肺叶切除术患者围术期胰岛素抵抗的影响。方法30例择期全麻下行肺叶切除手术的患者，随机分为曲马朵组（T组）和对照组（C组）。T组切皮之前5min，给予患者曲马朵1．5mg／kg，术中持续0．5mg·kg^-1·h^-1“泵人曲马朵。C组给予等量0．9％氯化钠注射液。分别检测麻醉诱导前即刻（T0）、手术结束时（T1）、手术结束后4h（T2）、术后第2天早晨7：00（L3）患者血糖、胰岛素、白介素45（IL-6）和肿瘤坏死因子（TNF-α）的水平，并计算胰岛素敏感性。结果与T0比较，TI、T2和L3时血糖、胰岛素、IL-6、TNF-α浓度均升高（均P〈0．05），胰岛素敏感性均降低（P〈0．05）。与C组比较，Tl、T2、T2时T组血浆血糖、胰岛素、IL-6、TNF-α仪浓度均较低（均P〈0．05），胰岛素敏感性均较高（均P〈0．05）。结论曲马朵可通过降低血浆TNF-α、IL-6的水平从而减轻手术创伤引起的围术期胰岛素抵抗。

The effect of tramadol on perioperative insulin resistance in patients undergoing pulmonary lobectomy

Objective To investigate the effect of tramadol on perioperative insulin resistance in patients un dergoing pulmonary lobectomy.Methods Thirty patients undergoing pulmonary lobectomy,were randomly divided in to two groups :group T(tramadol group)and group C (control group), five minutes before skin incison, group T re ceived tramadol 1.5 mg/kg intravenously (IV), followed immediately by a continuous infusin of 0.5mg/kg per hour until the end of surgery, and the control group received normal saline instead of tramadol.Blood samples were takenfrom vein for determination of plasma blood sugar,insulin, IL-6 and TNF-α concentrations before induction of anesthe sia(T0) ,at the end of the operation(T1) ,four hours after operation(T2)and seven oclock on the next morning(T3),and the value of ISI was calculated.Results The concentrations of blood sugar, insulin,TNF-α and IL-6 at T1 andT2 ,T3 increased significantly compared to baseline(T0) in both groups(P ＜ 0.05).The concentrations of blood sugar,insulin,IL-6 and TNF-o at T1 ,T2 and T3 were significantly lower in group T than that in group C (P ＜0.05).Thevalue of ISI was significantly higher in group T than that in group C (P ＜ 0.05).Conclusion Tramadol could allevi ate perioperative insulin resistance in patients undergoing pulmonary lobectomy by inhibiting plasma blood sugar,insu lin,IL-6 and TNF-α.