两种不同麻醉和镇痛方法对术后胰岛素抵抗状态影响的比较  

A comparison of effect of epidural anesthesia/PCEA with general anesthesia/PCIA on postoperative insulin-resistant state in patients with insulin-resistance

作　　者：郑颖梅[1] 陆曙炎[2] 徐南伟[3] 李立[1] 胡继红[4] 

机构地区：[1]南京医科大学附属常州第二人民医院麻醉科,常州市213003 [2]南京医科大学附属常州第二人民医院泌尿科,常州市213003 [3]南京医科大学附属常州第二人民医院骨科,常州市213003 [4]南京医科大学附属常州第二人民医院内分泌科,常州市213003

出　　处：《临床麻醉学杂志》2007年第9期732-735,共4页Journal of Clinical Anesthesiology

摘　　要：目的研究两种不同麻醉方法对术前存在胰岛素抵抗(IR)患者术后IR的影响。方法利用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR),筛选术前存在IR的择期髋关节置换术患者64例,将患者随机均分为两组:研究组和对照组。采用视觉模拟评分法(VAS)观察术后48h内的镇痛效果。分别于麻醉前30min(T0)、手术结束时(T1)、术后24h(T2)、48h(T3)测定血浆葡萄糖(FPG)、胰岛素(FINS)浓度并计算出相应HOMA指数用以判断患者术后IR状态。结果两组VAS差异均无统计学意义。研究组FPG、FINS、ln(HOMA-IR)在T1时均显著降低(P<0.01),但FPG在T2时基本恢复至术前,而FINS、ln(HOMA-IR)与T0时比差异均有统计学意义(P<0.01)。对照组FPG始终变化不大,而FINS、ln(HOMA-IR)T1、T2时升高显著(P<0.05或P<0.01)。T3时研究组ln(HOMA-IR)依然很低(1.13±0.26)(P<0.01),而对照组基本恢复至术前(1.50±0.51)。结论硬膜外麻醉(EA)+硬膜外自控镇痛(PCEA)在术后48h内可以减轻术前存在IR患者的术后IR程度,尤其在术后即时作用最明显。Objective To compare the effects of epidural anesthesia（EA） followed by patientcontrolled epidural analgesia （PCEA） with general anesthesia followed by patient-controlled intravenous analgesia on postoperative insulin-resistant state in patients with insulin-resistance（IR）. Methods Sixty-four patients with HOMA-IR≥2.31 undergoing hip arthroplasty were divided into gorup E and G with 32 cases each. The patients in group E were given epidural anesthesia and PCEA, and those in gorup G inhalation combined intravenous anesthesia and PCIA. Analgesia was assessed with visual analog scale（VAS） in the early 48h after surgery. Fasting glucose and fasting insulin were examined at 30 rain before anesthesia（T0 ）, at the end of surgery（T1 ）, 24 h（T2 ） and 48 h（T3 ） after surgery to calculate HOMA value so as to determine the postoperative state of IR. Results Epidural anesthesia and analgesia significantly influenced the postoperative HOMA score in the first 48 h after surgery（P〈0.01） ,especially at the end of surgery. Conclusion Compared to general anesthesia, EA followed by PCEA can more effectively decrease postoperative IR state in patients with IR.

关 键 词：硬膜外麻醉 全身麻醉 胰岛素抵抗 稳态模式评估法 

分 类 号：R614[医药卫生—麻醉学]