【摘要】 为观察应激时血糖代谢与神经内分泌改变的关系，探讨胰岛素抵抗的机制和意义。对外科大手术后病人30例，于术毕即刻（AS）、脱离呼吸机后（AW）和术日次晨（NW）分别测定外周血糖和胰岛素（INS）、C－肽（GP）、皮质醇（CDRT）、促肾上腺皮质素（ACTH）、生长激素（GH）、胰高糖素（GL）（以上放免法），肾上腺素（E）和去甲肾上腺素（NE）（高效液相色谱法）水平。结果：术后患者的血糖及CORT、ACTH、E和NE均显著升高，分别为2．3g／L，280．7μg／L、47．6ng／L、324．4ng／L和1511．0ng／L，脱机后逐渐下降，至次展显著降低，分别为1．89g／L、134．4μg／L、7．38ng／L、92．6ng／L和9755ng／L。C－P明显升高并和INS一起逐渐递增，在AS和NM分别为3．59μp／Lvs．5．27μg／L和20．8mU／Lvs．32．7mU／L。GH和GL3个时相均在正常范围。结论：外科术后早期存在应激性高血糖和胰岛素抵抗，血糖水平主要受NE调节，24小时后逐渐复常，胰岛素抵抗的原因在于效应细胞的受体下调，是机体应激时重要的自我保护手段。更多还原

【Abstract】 To observe the dynamic changes of glucose and glucorglatory hormones during early stage after surgery and investigate the mechanism of insulin-resistance. Prospective. SICU in university hopsital. 30 patients after maor operation. The blood glucose(BG), insulin(INS), C-peptide(C-P), corti- sol (CORT), ACTH, growth-hormone (GH), glucarm (GL), [by radio-immuno assay (RIA) ], epinephrine(E) and norepinephrine (NE) by high performance liquid chrornatography (HPLC) were measured after surgery (AS),after (ventilator) weaning (AW) and the next morning of surgery (NM) respectively. The results were analyzed by rank sum test and multiple linear corralation. Results: There were significant increases of BG(2. 3g/L), CORT(280. 7μg/L), ACTH(47. 6ng/L), E(324. 4ng/L) and NE(1 51 1. 0ng/L) at AS. Since AW, the elevation stopped and shawed a trend of returning to nor- mal,at NM, the above values decreased to: BG(1. 89g/L), CORT(134. 4μg/L), ACTH(7. 38ng/L), E (92. 6ng/L) and NE(975. 5ng/L). The INS and GP showed a steady increase from AS to NM(20. 7gmU/L vs. 32. 69mU/L and 3. 59μg/L vs. 5. 27μg/L resqectively). hah GH and GL had no changes among 3 phaas. Chnclusions: At eaLrly post-operative stage, there were significant stress-induced hyper- glycemia and insulin-resistance, the level of blood glucose was regulated mainly by NE. Within 24 houre, the regulation of blood sugar was turning to normal. The mechanism of insulin-resistance was the down- regulation of target cells,which was a vital function of self-protection of body during stress.更多还原