腹腔神经丛阻滞对肝部分切除术后胰岛素抵抗的影响  

Effect of neurolytic celiac plexus block on insulin resistance after partial hepatectomy in rats

作　　者：李军[1] 魏晓红[2] 林露[1] 车建翔[3] 邱庆明[3] 闫洪涛[4] 安虹[1] 刘英海[1] 白树荣[1] 田伏洲[4] 

机构地区：[1]成都军区总医院麻醉科,四川成都610083 [2]成都军区总医院心脏外科 [3]解放军第44医院麻醉科 [4]成都军区总医院全军普通外科中心博士后工作站

出　　处：《中国急救医学》2013年第12期1124-1126,共3页Chinese Journal of Critical Care Medicine

基　　金：基金项目：“十二五”成都军区医学科学技术研究项目（c12005）;成都军区总医院院管课题（2011YG-B010）

摘　　要：目的观察腹腔神经丛阻滞（NCPB）对SD大鼠肝部分切除术（PH）术后胰岛素抵抗（IR）程度的影响。方法雄性SD大鼠，首先构建经典大鼠PH模型：即分别于肝左叶、中叶根部结扎切除。然后随机分为对照组和NCPB组。NCPB组在术后12h开始给予双侧0．5％利多卡因经皮NCPB（1次／d），而对照组以0．9％生理盐水替换。于术后第1、3、7天NCPB后30min测定血糖、胰岛素并计算胰岛素敏感指数（ISI），取比目鱼肌分别测定骨骼肌葡萄糖摄取量及TNF-α含量。结果PH术后两组大鼠血清胰岛素在相应时间点差异无统计学意义，第1天和第3天NCPB组血糖显著低于对照组，而ISI值显著高于对照组；NCPB组骨骼肌基础葡萄糖摄取量在第1天和第3天显著低于对照组，而胰岛素刺激葡萄糖摄取量在第1天和第3天却显著高于对照组；在PH术后第1、3、7天，NCPB组每毫克骨骼肌中TNF-α含量均显著低于对照组。结论NCPB可减轻PH术后IR程度，提高胰岛素敏感性和反应性，这可能不仅与其镇痛作用有关，还可能与抑制TNF—α分泌释放有关。Objective To investigate the effects of neurolytic celiac plexus block （NCPB） on the degree of insulin resistance after partial hepatectomy （PH） in rats. Methods The PH model was prepared as the method that the left and middle hepatic lobe was surgically removed from the male Sprague - Dawley rats. And all of rats were randomly divided into two groups at 12 h after PH ： NCPB group received NCPB with 0.5% lidocaine （once a day for 7 days）, and control group received the same procedures, but physiological saline was injected instead of 0.5% lidocaine. The concentration of blood glucose and serum insulin were determined, glucose uptake and the level of TNF - α in skeletal muscle was determined with radioreceptor assay and enzyme -linked immunosorbent assay at l d, 3d and 7d after PH, respectively. Results There were no statistical difference of the concentration of serum insulin between the control group and the NCPB group at the respective postoperatively time points after PH. And at the first and the third day after PH operation, the concentration of blood glucose and the basic glucose uptake were significantly lower in the NCPB group than those in the control group, and the insulin sensitivity index and glucose uptake with insulin stimulated in skeletal muscle were markedly higher in the NCPB group than those of control group. At the respective postoperatively time points, the levels of TNF - α in skeletal muscle in the NCPB group were significantly lower than those in control group. Conclusion These results indicate that NCPB exerts suppression on insulin resistance accompanying by the decreases of the insulin sensitivity and reactivity after PH operation, which is notonly related to pain relieving effects, but also related to inhibited releasing of TNF - α.

关 键 词：腹腔神经丛阻滞(NCPB) 肝部分切除术(PH) 胰岛素抵抗(IR) 肿瘤坏死因子-α(TNF—α) 葡萄糖摄取 

分 类 号：R730.5[医药卫生—肿瘤]