曲马朵对肺叶切除术患者围手术期胰岛素抵抗的影响.pdfVIP

曲马朵对肺叶切除术患者围手术期 胰岛素抵抗的影响 马 瑞 李志强 徐军美 徐振兴 目的 探讨静脉注射曲马朵对肺 叶切除术患者围术期胰岛素抵抗的影响。方法30例择期全 麻下行肺叶切除手术的患者，随机分为曲马朵组 （T组）和对照组 （C组）。T组切皮之前5min，给予患者曲马 朵1.5mg/kg，术中持续0.5mg·kg·h-1泵入曲马朵。C组给予等量0.9％氯化钠注射液。分别检测麻醉 诱导前即刻(T0)、手术结束时(T1)、手术结束后4h(T2)、术后第2天早晨7：00(T3)患者血糖、胰岛素、白介 素-6(IL-6)和肿瘤坏死因子(TNF-α)的水平，并计算胰岛素敏感性。结果与T0比较，T1、T2和T3时血糖、 胰岛素、IL-6、TNF-α浓度均升高 （均P＜0.05），胰岛素敏感性均降低(P＜0.05)。与C组比较，T1、T：、T2时T 组血浆血糖、胰岛素、IL-6、TNF-α浓度均较低 （均P＜0.05），胰岛素敏感性均较高 （均P＜0.05）。结论曲马 朵可通过降低血浆TNF-αt、IL-6的水平从而减轻手术创伤引起的围术期胰岛素抵抗。 ． 曲马多；手术期间；胰岛素抵抗；肿瘤坏死因子；白细胞介素6 Theeffectoftramadolonperioperativeinsulinresistanceinpatientsundergoingpulmonarylobectomy MARui* LIZhi-qiangXUJun-meiXUZhen-xing*DepartmentofAnesthesiology,TheCentralHospitalofFengxianDistrict, Shanghai201400,China Objective Toinvestigatetheeffectoftramadolonperioperativeinsulinresistanceinpatientsun dergoingpulmonarylobectomy.Methods Thirtypatientsundergoingpulmonarylobectomy,wererandomlydividedin totwogroups:groupT(tramadolgroup)andgroupC(controlgroup),fiveminutesbeforeskinincison,groupTre ceivedtramadol1.5mg/kgintravenously(IV),followedimmediatelybyacontinuousinfusinof0.5mg/kgperhour untiltheendofsurgery,andthecontrolgroupreceivednormalsalineinsteadoftramadol.Bloodsamplesweretaken fromveinfordeterminationofplasmabloodsugar,insulin,IL-6andTNF-αconcentrationsbeforeinductionofanesthe sia(T0),attheendoftheoperation(T1),fourhoursafteroperation(T2)andsevenoclockonthenextmorning(T3), andthevalueofISIwascalculated.Results Theconcentrationsofbloodsugar,insulin,TNF-αandIL-6atT1and T2,T3increasedsignificantlycomparedtobaseline(T0)inbothgroups(P＜ 0.05).Theconcentrationsofbloodsugar, insulin,IL-6andTNF-oatT1,T2andT3weresignificantlyloweringroupTthanthatingroupC(P＜0.05).The valueofISIwassignificantlyhigheringroupTthanthatingroupC(P＜ 0.05).Conclusion Tramadolcouldallevi ateperioperativeinsulinresistanceinpatientsundergoingpulmonarylobectomybyinhibitingplasmabloodsugar,insu lin,IL-6andTNF-α. Tramadol;Intraop