【摘要】 目的比较舒芬太尼和芬太尼麻醉对腹腔镜胆囊切除手术患者血糖和胰岛素水平的影响,并利用代谢组学技术探讨作用机制。方法 2015年4月至2016年10月拟行腹腔镜胆囊切除手术的患者60例,男37例,女23例,ASAⅠ或Ⅱ级。随机分为舒芬太尼组和芬太尼组,每组30例。于麻醉前、插管后5min、术中40min及术后2h采集静脉血检测血糖和胰岛素浓度,分析术后2h的胰岛素代谢组学。结果插管后5min、术中40min及术后2h舒芬太尼组血糖浓度均明显低于芬太尼组(P<0.05)。术后2h舒芬太尼组胰岛素浓度明显低于芬太尼组(P<0.05)。代谢组学分析表明,在正离子模式下,采用校正偏最小二乘判别分析,两组患者根据术后2h的血清代谢产物能够形成明显的分类,两种药物血清代谢物谱存在明显的不同,并发现了5个同血糖和胰岛素密切相关的生物标志物。结论舒芬太尼对患者的血糖和胰岛素影响较小,更适合胆囊切除手术患者麻醉,其机制可能同两种药物对糖代谢和胰岛素代谢的相关环节影响不同而密切相关。更多还原

【Abstract】 Objective To compare the effects of sufentanil and fentanyl anesthesia on blood glucose and insulin levels in patients undergoing laparoscopic cholecystectomy,and explore the mechanism using metabonomics technique.Methods Total 60 patients,37 males and 23 females,ASA physical statusⅠorⅡundergoing laparoscopic cholecystectomy were randomly divided into sufentanil and fentanyl groups,and 30 cases in each group.Venous blood was collected before anesthesia and 5 min,40 min and 2 hafter anesthesia,which was used to detect blood glucose,insulin levels and metabonomics analysis.Results Blood glucose were significantly lower in sufentanil group than in fentanyl group at 5 min after intubation,40 min in surgery,and postoperative 2 h(P<0.05).After 2 h,insulin in sufentanil group was significantly lower than that in fentanyl group(P<0.05).Metabolic analysis showed that in the positive ion mode,using orthogonal partial least squares discriminant analysis,the patients in the two groups were classified according to the serum metabolites at postoperative 2 h,which showed that the serum metabolites in patients of different groups were significantly different,and 5 biomarkers closely related to blood glucose and insulin were found.Conclusion Sufentanil showed slighter effects on blood glucose and insulin in patients,and more suitable for cholecystectomy patients.The mechanism may be related with the glucose and insulin metabolism.更多还原