曲马多对不同创伤程度手术围手术期胰岛素抵抗的影响

目的 探讨静脉注射曲马多对不同创伤程度手术围手术期胰岛素抵抗(IR)的影响.方法 选择拟在全麻下行择期腹部手术的普外科和妇科患者120例,按随机数字表法分为曲马多组和对照组,每组各60例.曲马多组切皮前5 min静脉注射曲马多1.5 mg/kg,继以0.5 ms/(kg·h)泵入直到手术结束;对照组相应给予等量0.9%氯化钠,术中瑞芬太尼以0.1 μg/(kg·min)静脉维持.根据手术创伤评分(POSSUM评分)将曲马多组和对照组患者分为Ⅰ、Ⅱ、Ⅲ三个亚组.分别于麻醉诱导前即刻(To)、手术结束时(T1)、术后第2天清晨(T2)采集静脉血,测定血糖、胰岛素,计算胰岛素敏感指数(ISI),并进行比较.结果 曲马多组的各亚组间血糖、胰岛素、ISI在T0时比较差异均无统计学意义(P＞0.05),亚组内T1、T2的血糖、胰岛素均较T0升高T0分别为(4.74±0.43)mmol/L、(15.25±1.22)U/L,T1分别为(5.35±0.47)mmol/L、(17.74±1.45)U/L,T2分别为(6.55.4±0.53)mmol/L、(18.59±1.56)U/L],ISI均降低,差异有统计学意义(P＜0.05).与对照组同一时间点比较,曲马多组的各亚组在T1、T2时血糖、胰岛素均较低,ISI均较高,差异有统计学意义(P＜0.05).结论 IR与手术创伤程度相关,随着手术创伤程度增加,胰岛素敏感性下降,IR增大;曲马多可减轻手术创伤引起的围手术期IR.

The effect of tramadol on insulin resistance in the perioperative of surgical operations with different trauma

Objective To investigate the effect of tramadol on perioperative insulin resistance in patients undergoing surgical operations with different trauma.Methods One hundred and twenty patients who had general and gynecology belly all numb surgical operation were divided into tramadol group and control group,each with 60 cases.Five minutes before skin incision,the tramadol group was given tramadol 1.5 mg/kg intravenously.followed immediately by a continuous infusion of 0.5 mg/kg per hour until the end of surgery,and the control group was given normal saline instead of tramadol.Blood samples were taken from vein for determination of plasma blood sugar,insulin concentrations before induction of anesthesia(T0),at the end of the operation(T1)and seven o'clock on the next morning(T2).The value of ISI Was calculated.Grading upon the trauma degree of surgical operation was divided into three groups(Ⅰ,Ⅱ,Ⅲsubgroup).Results The concentrations of blood sugar and insulin at Tohad no significant difference in Ⅰ,Ⅱ,Ⅲsubgroups in the tramadol group(P＞0.05).The concentrations of blood sugar and insulin at T1,T2 were increased significantly compared to T0 in each subgroupTo:(4.74 ±0.43)mmol/L,(15.25±1.22)U/L;T1:(5.35±0.47)mmol/L,(17.74±1.45)U/L;T2:(6.55±0.53)mmol/L,(18.59±1.56)U/L](P＜0.05),ISI was decreased(P＜0.05).The concentrations of blood sugar and insulin at T1,T2 were significantly lower in the tramadol group than those in the control group.The value of ISI was significantly higher in the tramadol group than that in the control group(P＜0.05).Conclusions The insulin resistance presents relation with the surgical operation degree.The severe the wound is,the bigger insulin resistance is.Tramadol can alleviate perioperative insulin resistance in patients undergoing surgical operations.