雷米芬太尼复合全麻对心肺转流期胰岛素抵抗的影响  

Effects of remifentanil combined with propofol and isoflurane anesthesia on insulin resistance in patients undergoing cardiopulmonary bypass

作　　者：邵栋[1] 李立[1] 恽惠方[1] 邹志清[1] 周永红[1] 

机构地区：[1]南京医科大学附属常州二院麻醉科,213003

出　　处：《临床麻醉学杂志》2008年第7期563-565,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较雷米芬太尼或芬太尼复合丙泊酚、异氟醚麻醉对心肺转流（CPB）期胰岛素抵抗的影响。方法择期CPB下心脏瓣膜置换术患者20例，随机均分为雷米芬太尼复合丙泊酚、异氟醚麻醉组（R组）和芬太尼复合丙泊酚、异氟醚麻醉组（F组），分别测定麻醉前（T0）、CPB前5min（T1）、CPB15min（T2）、开放升主动脉后15min（T3）和停CPB后15min（T4）的血胰岛素（Ins）、C-肽、皮质醇（Cor）和血糖（BG），计算胰岛素敏感性指数（ISI）和1gHOMA值。结果两组T2～T4的Ins、C-肽、BG均较T0和T1明显上升（P〈0．05或P〈0．01）；R组T3、T4Ins、C-肽上升幅度明显低于F组（P〈0．01），但此两时点BG值差异无统计学意义。两组Cor在T1～T4较T0时明显上升（P〈0．01），且R组上升幅度明显低于F组（P〈0．01）。两组ISI在T2～T4较T0和T1时均下降（P〈0．01），且R组下降幅度明显低于F组（P〈0．01）。1gHOMA值在T1～T4较T0时明显上升（P〈0．01），在T3、T4时，R组上升幅度明显低于F组（P〈0．01）。结论CPB中血Cor和BG浓度增加明显。CPB期间存在明显的胰岛素抵抗现象；雷米芬太尼复合丙泊酚、异氟醚麻醉较芬太尼复合丙泊酚、异氟醚麻醉匿能抑制Cor上升，改善术中胰岛素抵抗的程度。Objective To compare the effects of remifentanil or fentanyl combined with propofol and isoflurane anesthesia on insulin resistance in patients undergoing cardiopulmonary bypass （CPB）. Methods Twenty patients undergoing cardiac valve replacement under CPB were randomly divided into two groups with 10 cases each. The patients in group R were given remifentanil combined with propofol and isoflurane anesthesia and those in group F fentanyl combined with propofol and isoflurane. Blood samples were obtained before anesthesia（T0 ）, at 5 min before CPB （T1）, 15 min after CPB（T2 ）, 15 min after declamping of aorta （T3）, 15 min after CPB（T4 ）. Plasma insulin（Ins）, C-peptide, cortisol （Cor）and blood glucose （BG） were measured. The insulin-sensitivity index （ISI） was calculated. Results Values of Ins, c-peptide and BG in two groups were higher at T2 ,T3 and T4 than those at T0 and T1 （P〈0.01） ,which of group R were significantly higher than those of group F at Ta and T4 （P〈0.01）. Cor in two groups was higher at T1 to T4 than that at To , which of group R was significantly higher than that of group F at T3 to T4 （P〈0.01）. ISI in two groups was higher at T2 ,T3 and T4 than that at T0 and T1 , which of group R was significantly higher than that of group F at T2 ,T3 and T4 （P〈0.01）. 1gHOMA [1g（Ins× BG/22.5）] of both groups was higher at T1 to T4 than that at T0, which of group R was significantly lower than that of group F at T3 and T4 （P〈 0.01）. Conclusion There is an obvious increase of concentrations in Cor and BG in the patients undergoing cardiac valve replacement under CPB. Insulin resistance is present and remifentanil combined with propofol and isoflurane anesthesia inhibits endocrine stress hormones better than fentanyl.

关 键 词：心肺转流 胰岛素抵抗 雷米芬太尼 芬太尼 

分 类 号：R614[医药卫生—麻醉学]