【作者】 马瑞；

【导师】 徐军美；

【作者基本信息】 中南大学 ， 麻醉学， 2007， 硕士

【摘要】 目的：探讨静脉注射曲马多对肺叶切除术患者围术期胰岛素抵抗的影响。方法：30例择期早晨八点三十分行肺叶切除手术的患者，ASA分级Ⅱ～Ⅲ级、昼夜节律、年龄、身高、体重指数（BMI）的差异无显著性。高血压、糖尿病、肝、肾功能受损者予以排除。随机分为曲马多组（T组）和对照组（C组），每组15例。T组切皮之前5分钟，给予患者曲马多1.5mg／kg，静推。接着持续按每小时0.5mg／kg泵入曲马多，直到手术结束，术中按镇痛等效价减少芬太尼用量。C组给予于曲马多等量生理盐水。余麻醉方案两组相同。分别于麻醉诱导前即刻（T₀）、手术结束时（T₁）、手术结束后4小时（T₂）术后第二日早晨七点（T₃）抽取静脉血3毫升，即刻取少许测血糖值，余肝素抗凝后以3000r／min离心15分，留取血浆标本于—20摄氏度冷冻保存待测。全部标本留齐后用放射免疫法测定胰岛素、IL-6和TNF—α的值。胰岛素敏感性计算采用李光伟等提出的血糖与胰岛素的乘积的倒数计算。统计学处理：计量资料以均数±标准差（（?）±s）表示。采用SPSS14.0软件，组内进行配对t检验分析；组间进行单因素方差分析，计数资料以卡方x²检验，P＜0.05为有差异有显著性。结果：两组患者年龄、身高、体重、BMI值、手术时间的差异无显著性（P＞0.05）。两组患者T₀时血糖、胰岛素、IL—6、TNF—α和胰岛素敏感性的差异无显著性（P＞0.05）：与T₀比较，T₁、T₂和T₃时两组血浆血糖、胰岛素、IL—6、TNFa浓度均升高（P＜0.05），胰岛素敏感性均降低（P＜0.05）。与C组比较，T₁、T₂、T₂时T组血浆血糖、胰岛素、IL—6、TNF—α浓度均较低（P＜0.05），胰岛素敏感性均较高（P＜0.05）。结论：盐马多可通过降低血浆TNF—α、IL—6的水平从而减轻手术创伤引起的围术期胰岛素抵抗。更多还原

【Abstract】 Objective: The purpose of this study was to investigate the effect oftramadol on perioperative insulin resistance in patients undergoingpulmonary lobectomy.Methods: Thirty patients undergoing pulmonary lobectomy at half pasteight, which had no signs of HBP,DM,Iiver function failure and renal failure,no significant difference existed between two groups in ASA grade,age,bodyheight and BMI value,were randomly divided into two groups of 15 patientseach: five minutes before skin incison, resecting the pulmonary lobe tramadolgroup received tramadol 1.5mg/kg intravenously（Ⅳ）,followed immediatelyby a continuous infusin of0.5mg/kg per hour until the end of surgery,and thecontrast group received normal saline instead-of tramadol. Blood sampleswere taken from vein for determination of plasma blood sugar、insulin, IL—6 and TNF—αconcentrations before induction of anesthesia （T₀）、at theend of the operation （T₁）、four hour after operation（T₂） and seven o’clock onthe next morning （T₃）. The value of ISI was determined with the formulaintroduced by Li Guangwei which calculate the value of ISI with thereciprocal of the cross product of BS and insulin value. Statisticstreatment:The measurement data was expressed as "（?）±s", The measurementcount was expressed as "x²", and using Independent-Samples T Test program and One-Way ANOVA program of SPSS 14.0 software to analyzeit.when the value of "P" is lower than 0.05,it has significance.Results: The age、body height、body weight、value of BMI andoperation time had no significant difference in both groups （P＞0.05）. TheNIBP、HR、SPO₂、BIS had no significant difference in both groups （P＞0.05）.The vomiting had no significant difference in both groups（x²＞0.05）. The concentrations of blood sugar、insulin、TNF—αand IL—6 at To had no significant difference in both groups （P＞0.05）. Theconcentrations of blood sugar、insulin、TNF—αand IL—6at T₁ and T₂、T₃increased significantly compared to baseline（T₀） in both groups（P＜0.05）.The concentrations of blood sugar、insulin、IL—6 and TNF—αatT₁、T₂and T₃ were significantly lower in tramadol group than that in contrastgroup （P＜0.05）, The value of ISI was significantly highter in tramadol groupthan that in contrast group （P＜0.05）.Conclusion: Tramadol can alleviate perioperative insulin resistance inpatients undergoing pulmonary lobectomy by inhibiting plasma blood sugar、insulin、IL—6 and TNF—a.更多还原