术后镇痛对老年患者上腹部手术胰岛素敏感性的影响

目的探讨术后镇痛及镇痛方式对老年患者术后胰岛素抵抗程度的影响。方法45例择期行上腹部手术的老年非糖尿病患者,随机分为3组,每组15例,Ⅰ组全麻联合硬膜外阻滞并保留术后镇痛;Ⅱ组全麻并行术后静脉镇痛;Ⅲ组全麻后不保留术后镇痛。所有患者分别于术前（硬膜外穿刺或全麻诱导前）、术后第1天清晨测定血浆血糖（G）、血清胰岛素（INS）。计算胰岛素敏感性指数（ISI）。观察记录3组术后2、4、8、16、24、48h患者疼痛评分（VAS）。结果3组术后G、INS水平均明显高于术前,ISI均明显低于术前,差异均有统计学意义（均P〈0.05）。Ⅲ组术后G、INS明显高于Ⅰ、Ⅱ组,ISI明显低于Ⅰ、Ⅱ组,差异均有统计学意义（均P〈0.05）。Ⅰ、Ⅱ组VAS差异无统计学意义（P〉0.05）。Ⅰ组和Ⅱ组术前、术后第1天G、INS、ISI差异均无统计学意义（均P〉0.05）。结论老年患者术后镇痛能明显改善腹部手术后胰岛素抵抗程度。不同镇痛模式对术后第1天胰岛素敏感性改变无明显影响。

Effect of Methods of Postoperative Analgesia on Insulin Sensitivity in Elderly Patients Undergoing Upper Abdominal Surgery

Objective To investigate effect of two different postoperative analgesia methods applied to upper abdominal surgeries on concentrations of glucose（G） and insulin （INS） in the perioperation period. Methods Forty-five elderly patients without diabetes mellitus scheduled for upper abdominal surgeries were randomly divided into three groups with 15 cases in each. The patients in group Ⅰ received general anesthesia combined with epidural block and postoperative analgesia, group Ⅱ received general anesthesia and postoperative intervenous analgesia ,the remaining patients in group m received general anesthesia only. The concentrations of G and INS were measured at two different time points which was before anesthesia induction and 1 days after operation. The insulin sensitivity index （ISI） was calculated. Visual analog scale （VAS） were measured at six different time points that is 2nd, 4th, 8th, 16th, 24th and 48th after operation. Results The levels of plasma G and INS in the three groups were significantly increased on the first postoperative day compared with that before anesthesia induction, the ISI level was significantly decreased simuhaneously（P〈0.05）. The levels-of plasma G and INS in groups Ⅲ were significantly increased on the first postoperative day compared with those in group Ⅱ and group Ⅰ （P〈0.05）. The ISI level was significantly decreased simultaneously in group Ⅲ compared with that in group Ⅱ and group Ⅰ （P〈0.05）. VAS were no difference between group Ⅰ and group Ⅱ in different time（P〉0.05）. There was no difference in concentration of G, INS and ISI for pre-anesthesia induction and the first postoperative day between group Ⅰ and group Ⅱ （P〉0.05）. Conclusion Postoperative analgesia technology can decrease the degree of insulin resistant in elderly patients. For the two different analgesic methods, intravenous or epidural there was no effect on the ISI at the first postoperative day.