超前镇痛对肝癌手术患者胰岛素抵抗及血清创伤应激因子水平的影响  

Effect of preemptive analgesia on the level of insulin resistance and the degree of traumatic stress in patients with liver cancer before and after operation

作　　者：周纲[1] 应婷婷[1] 叶永青[1] ZHOU Gang;YING Ting-ting;YE Yong-qing(Department of Anesthesiology,Taizhou Hospital,Taizhou,Zhejiang 317000,China)

机构地区：[1]浙江省台州医院麻醉科

出　　处：《中国卫生检验杂志》2019年第17期2116-2118,共3页Chinese Journal of Health Laboratory Technology

摘　　要：目的探讨超前镇痛对肝癌手术前后患者胰岛素抵抗及血清中创伤应激因子水平的影响。方法选择2016年3月-2017年3月在本院行肝癌根治术患者90例作为研究对象,按照随机数字表法分为观察组和对照组各45例,观察组患者采用术前超前镇痛,对照组患者给予肝癌常规镇痛,2组患者均采用肝癌根治术治疗,对比2组患者手术后应激反应程度及胰岛素抵抗水平。结果术后观察组患者GLU、HOMA-IR低于术前和对照组,FIN则高于术前和对照组,差异均有统计学意义(P <0.05),术后6 h、12 h、24 h、48 h机械痛阈值均低于术前(P <0.05),观察组术后各时间点机械痛阈值均高于对照组,术后观察组血清血糖、去甲肾上腺素、肾上腺素、皮质醇、醛固酮水平均低于对照组,术后观察组血清CRP、IL-1α、IL-6、TNF-α水平明显低于对照组,差异均有统计学意义(P <0.05)。结论超前镇痛有助于改善胰岛素抵抗,降低创伤应激反应程度。Objective To investigate the effects of preemptive analgesia on the insulin resistance and the degree of surgical stress in patients with liver cancer before and after operation. Methods 90 patients with liver cancer radical surgery in our hospital were selected from March 2016 to March 2017 as subjects,and randomly divided into observation group and control group,with 45 cases in each group. The observation group were treated by preoperative analgesia,the control group were treated with routine liver analgesia program,two groups of patients were treated by radical hepatocellular carcinoma,and the level of stress reaction and insulin resistance were compared between two groups after surgery. Results GLU and HOMA-IR of the postoperative observation group were lower than those of the preoperative group and control group,FIN was higher than that before treatment and the control group,with the differences statistically significant ( P < 0. 05). The mechanical pain thresholds at 6 h,12 h,24 h,and 48 h after operation were lower than those before operation ( P < 0. 05). The mechanical pain threshold at each time point in the observation group was higher than that in the control group. The levels of norepinephrine,adrenaline, cortisol and aldosterone were lower than those in the control group. The levels of serum CRP,IL-1α,IL-6 and TNF-α in the postoperative observation group were significantly lower than those in the control group,with the differences statistically significant ( P < 0. 05). Conclusion Preemptive analgesia helps to improve insulin resistance and reduce the extent of traumatic stress response.

关 键 词：超前镇痛 胰岛素抵抗 创伤应激 肝癌 

分 类 号：R735.7[医药卫生—肿瘤]