创伤后早期神经内分泌改变与应激性高血糖  

GLUCOREGULATORY HORMONE CHANGES AND STRESS-INDUCED HYPERGLYCEMIA IN EARLY POST-OPERATIVE STAGE

作　　者：安友仲[1] 祝学光[1] 杜如昱[1] 赵华[1] 王新慧[1] 吴小英[1] 

机构地区：[1]北京医科大学人民医院外科,100044

出　　处：《北京医科大学学报》1997年第4期362-365,共4页Journal of Peking University(Health Sciences)

摘　　要：目的：观察应激时血糖代谢与神经内分泌改变的关系，探讨胰岛素抵抗的机制和意义。方法：前瞻性，教学医院SICU，外科大手术后病人30例。于术毕即刻（AS）、脱离呼吸机后（AW）和术日凌晨（NM）分别测定外周血糖和胰岛素（INS）、C肽（C-P）、皮质醇（CORT）、促肾上腺皮质素（ACTH）、生长激素（GH）、胰高糖素（GL）（以上放免法），肾上腺素（E）和去甲肾上腺素（NE）（高效液相色谱法）水平。结果采用秩和检验及多元直线相关进行统计学分析。结果：术后患者的血糖及CORT、ACTH、E和NE均显著升高，分别为2．3g／L、280．7μg／L、47．6ng／L、324.4ng／L和1511．0ng／L；脱机后逐渐下降，至凌晨显著降低，分别为1．89g／L、134．4μg／L、7．38ng／L、92．6ng／L和975．5ng／L。C－P明显升高并和INS一起逐渐递增，在AS和NM分别为3．59μg／L，对5．27ng／L和20．8mU／L对32．7mU／L。GH和GL3个时相均在正常范围。结论：外科术后早期存在应激性高血糖和胰岛素抵抗，血糖水平主要受NE调节，24h后逐渐复常；胰岛素抵抗的原因在效应细胞受体下调，是机体应激时重要的自我保护手段。Obective: To observe the dynamic changes of glucose and glucoregulatory hormones during earlystage after surgery and investigate the mechanism of insulin-resistance. Methods: 3O patients' blcod glucose(BG), insulin(INS), G-peptide (C-P), cortisol (CORT ), ACTH, growth-hormone (GH), glucagon (GL), [ byradioimmuno assay (RIA ) ], epinephrine (E ) and norepinephrine (NE ) [ by high performance liquidchromatography(HPLC) ] were measured after surgery(AS), after (ventilator) weaning(AW) and. the nextmorning of surgery (NM) respectively. The results were analyzed by rank sum test and multiple linearcorrelation. Results: There were significant increases of BG(2. 3 g/L), CORT(280. 7 μg/L), ACTH(47. 6ng/L), E(324. 4 ng/L) and NE(1511. 0 ng/L,) at AS. Since AW, the elevation stopped and showed a trendof returning to normal; at NM, the above values decreased to: BG(1. 89 g/L), CORT(134. 4 μg/L), ACTH(7. 38 ng/L), E(92. 6 ng/L) and NE(975. 5 ng/L,). The INS and C-P showed a steady increase from AS toNM(20. 76 mU/L vs 32. 69 mU/L and 3. 59 μg/L vs 5. 27 μg/L respectively). Both GH and GL had nochanges among 3 phases. Conclusion: At eariy post-operative stage, there were significant stress-inducedhyperglycemia and insulin-resistance, the level of blood glucose was regulated mainly by NE. Within 24 hours,the regulation of blood sugar returned to normal. The mechanism of insulin-resistance is the down-regulation oftarget cells, which is a vital function of self-protection during stress.

关 键 词：应激反应 去甲肾上腺素 胰岛素 创伤 高血糖 

分 类 号：R641.02[医药卫生—外科学]