糖耐量减低和正常老年患者全膝置换术后胰岛素抵抗状况的比较研究  

Insulin resistance in elderly patients with impaired or normal glucose tolerance after total knee arthroplasty

作　　者：郭小文[1] 吕晨[1] 郑晖[1] 陶涛[1] 

机构地区：[1]浙江省中医院麻醉科,杭州310006

出　　处：《浙江医学》2015年第15期1288-1290,1312,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生一般研究计划(2012KYA142)

摘　　要：目的研究糖耐量减低患者和正常的老年患者行全膝置换术后对胰岛素抵抗的影响。方法对60例择期行全膝置换术患者进行口服糖耐量试验(OGTT),根据结果分成糖耐量减低组(IGT组)和糖耐量正常组(对照组),各30例。分别测定入手术室后、手术拔管后30min、术后1、3、7d的空腹血糖和胰岛素浓度,计算相应胰岛素抵抗指数,采用视觉模糊痛疼评分(VAS)评估手术疼痛情况。结果两组间术前空腹血糖水平比较差异无统计学意义(P>0.05),对照组在手术拔管后30min和术后1d空腹血糖比较术前明显升高(P<0.05),IGT组在手术拔管后30min、术后1、3、7d空腹血糖比较术前均明显升高(均P<0.05),空腹血糖浓度明显高于对照组(P<0.05);IGT组胰岛素浓度和胰岛素抵抗指数在入手术室后、手术拔管后30min、术后1、3、7d均明显高于对照组(均P<0.05),对照组在手术拔管后30min和术后1d的胰岛素浓度和胰岛素抵抗指数相比均较术前明显升高(均P<0.05),而IGT组胰岛素浓度和胰岛素抵抗指数在手术拔管后30min、术后1、3、7d相比均较术前明显升高(均P<0.05);两组间VAS评分比较差异均无统计学意义(均P>0.05)。结论相对于糖耐量正常患者,IGT患者术后胰岛素抵抗程度较重并持续时间较长。Objective To assess insulin resistance in patients with impaired or normal glucose tolerance after total knee arthroplasty. Methods Sixty patients underwent elective total knee arthroplasty, including 30 cases with impaired glucose tolerance group （IGT group） and 30 cases with normal glucose tolerance（normal group）. Fasting glucose and insulin concentra- tions was measured before anesthesia, 30 min after extubation, postoperative dl, d3 and d7, respectively; and insulin resistance index was calculated. Visual Analog Scale （VAS） scores for pain were assessed 30 min after extubation, postoperative dl, d3 and d7, respectively. Results The fasting glucose levels both in normal and IGT groups were significantly elevated at 30 min after extubation and postoperative d 1 compared with those of preoperation（P〈0.05）; those in IGT group was also significantly elevated at postoperative d3 and d7（P〈0.05）; the fasting glucose levels in IGT group was significantly higher than those in normal group at all time points （P〈0.05）. The insulin concentration and insulin resistance index both in normal group and IGT group were signifi- cantly higher than those at 30 min after extubation and postoperative d 1, while those in IGT group were also higher at postopera- tive d3 and 7. The insulin concentration and insulin resistance index of IGT group were significantly higher than those of normal group at all time points. There was no statistical difference in VAS scores between two groups. Conclusion Compared to pa- tients with normal glucose tolerance, patients with IGT have a more serious and prolonged insulin resistance after total kneearthroplasty.

关 键 词：胰岛素抵抗 老年患者 麻醉 糖耐量减低 

分 类 号：R614[医药卫生—麻醉学]