吲哚美辛对感染病人糖代谢及胰岛素敏感性的影响  

EFFECT OF INDOMETHACIN ON THE GLYCOMETABOLISM AND THE SENSITIVITY OF INSULIN IN PATIENTS WITH INFECTION

作　　者：张斌[1] 张利华[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院

出　　处：《解放军医学杂志》2000年第4期261-263,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：探讨吲哚美辛对感染病人糖代谢及胰岛素敏感性的影响。选择严重腹腔感染病人 ,APACHEII >1 0分 ,血糖 >1 0mmol/L ,序贯分为两组 :对照组 8例 ;吲哚美辛组 7例 ,两组病人皆在静脉输液中加入普通胰岛素约 32U/d(胰岛素∶葡萄糖 =1∶4) ,吲哚美辛组吲哚美辛栓纳肛 ,1 0 0mg /d ,于实验开始前 1天及第 5天 ,分别采取标本和作项目测定。测定空腹血糖 ,肌酐、尿素氮、三酰甘油、游离脂肪酸浓度。应用间接能量测定仪测定能量消耗及底物氧化率 ,以及在第 5天作胰岛素耐量试验。两组病人应用胰岛素 5天后 ,血清Cr、BUN、TG及FFA水平皆有所下降 ,葡萄糖氧化率有所升高 ,但吲哚美辛组病人第 5天与第 1天比较有显著性意义 (P >0 .0 5) ,对于严重感染病人 ,静脉输注胰岛素的降糖效果并不明显 (P >0 .0 5) ,而加用吲哚美辛 ,其血糖水平降低较为显著 (P<0 .0 5)。胰岛素耐量试验结果显示 ,吲哚美辛组病人静脉注射胰岛素后 ,其降低血糖的速率明显增快 ,与对照组相比KI值显著增高 (3.8± 0 .8比 1 .8± 0 .4,P <0 .0 5)。给感染病人应用吲哚美辛 ,可增强胰岛素敏感性 ,促进机体对葡萄糖的氧化利用 ,改善糖代谢。To study the effect of indomethacin on insulin sensitivity and glycometabolism. Patients with severe intraabdominal infection(APACHE II score >10, glucose concentration >10 mmol/L) were selected and divided into two groups: Control( n =8) and INDO( n =7) groups. Patients in both groups were infused with insulin (32U/d), whereas indomethacin was put into rectum (100mg/d) of INDO patients. Samples and assessment were taken on d0 and d5, fasting blood glucose ,Cr ,BUN,TG,FFA were assayed and energy expenditure ,substrates oxidation rate were measured by indirect calorimetry, and insulin tolerance test was made on d5. Five days after insulin infusion , blood Cr, BUN, TG,FFA decreased and glucose oxidation rate increased to some degree in patients of both groups, but they were significantly higher on d1 than d5 in INDO group ( P <0.05). No antihyperglycemia effect of insulin infusion was found in septic patients, whereas significant reduction was found in blood glucose ( P <0.05). Result of insulin tolerance test showed that glucose decreased significantly after insulin injection in INDO group ,which had a higher KI value than that in control group. CONCLUSIONS Indomethacin could enhance insulin sensitivity, promote glucose utilization and improve glucose metabolism in severe septic patients.

关 键 词：腹腔感染 并发症 胰岛素抵抗 糖代谢紊乱 

分 类 号：R656.06[医药卫生—外科学] R587.05[医药卫生—临床医学]