腰丛神经阻滞对肥胖患者于全麻下行全髋关节置换术围术期胰岛素抵抗的影响

发布时间：2018-03-08 19:56

本文选题：腰丛神经阻滞　切入点：胰岛素抵抗　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对接受行髋关节置换术的肥胖患者围术期胰岛素抵抗相关指标的观察,旨在分析探讨腰丛神经阻滞对行人工全髋关节置换手术的肥胖患者围术期胰岛素抵抗的影响及其可能的机制,从而为行关节置换手术的肥胖患者围术期治疗提供参考依据。方法:选择全身麻醉下择期行人工全髋关节置换手术的患者80例,按患者BMI指数,将其分为肥胖组(F组)与正常体重组(C组),两组患者再随机分为不接受神经阻滞者(C1、F1组)和接受腰丛神经阻滞组(C2、F2组)。于术前(T0)、手术结束后即刻(T1)、手术结束后24h(T2)分别采静脉血,测定血糖(FBG)、胰岛素(Insulin,Ins)、IL-6、TNF-α并根据血糖及胰岛素计算胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR)。记录患者手术前后的Harris髋关节功能评分(Harris Hip Score)。结果:四组患者基础情况无统计学差异(P0.05)。F1与C1两组T1时FBG较T0时有所升高(P0.05),T2时Ins浓度较T0时刻显著升高(P0.05),T1、T2与T0时相比HOMA-IR升高,ISI降低,IL-6、TNF-α均升高(P0.05)。F1组T1时刻FBG较C1组显著升高(P0.05),T2时刻Ins浓度较显著升高(P0.05)。与C1组相比,F1组T1、T2时ISI降低,HOMA-IR,IL-6,TNF-α浓度升高(P0.05)。T1、T2时刻F2血糖值、IL-6、TNF-α较F1组显著降低,ISI显著增加(P0.05)。T1、T2时刻,F2组血糖、HOMA-IR显著低于C2组,ISI高于C2组(P0.05)。四组患者术后Harris髋关节评分较术前显著升高,F1组术后评分低于C1组,F2组评分较F1组更高(P0.05)。结论:1.接受全髋关节置换手术的肥胖患者围术期发生胰岛素抵抗较正常体重者更加显著。髋关节功能恢复的优良率较体重正常者低。2.腰丛神经阻滞可以降低接受全髋关节置换手术的肥胖患者围术期胰岛素抵抗。3.腰丛神经阻滞可以减轻全髋关节置换手术的肥胖患者围术期炎症反应,这可能是减轻围术期胰岛素抵抗的机制之一。
[Abstract]:Objective: to observe the relative indexes of insulin resistance in obese patients undergoing hip replacement. To investigate the effect of lumbar plexus nerve block on perioperative insulin resistance in obese patients undergoing total hip replacement and its possible mechanism. Methods: 80 patients undergoing total hip replacement under general anesthesia were selected according to the BMI index. They were divided into obesity group (F group) and normal weight group (C group). The two groups were randomly divided into two groups: group C _ 1 (without nerve block) and group C _ 2 F _ 2 with lumbar plexus nerve block. Venous blood was collected immediately after operation and 24 hours after operation. The blood glucose levels of FBG, insulin insulin, IL-6 and TNF- 伪 were measured, and insulin sensitivity index (ISI) and insulin resistance index (HOMA-IRI) were calculated according to blood glucose and insulin. The Harris hip function scores before and after operation were recorded. Results: there was no basic condition in the four groups. Compared with T0 time, the Ins concentration in T1 and C1 groups was significantly higher than that in T0 time. Compared with T0, the HOMA-IR level increased and the TNF- 伪 level in the F1 group was significantly higher than that in the C1 group. The FBG concentration at T1 time in the F1 group was significantly higher than that in the C1 group, and the Ins concentration at T2 time was significantly higher in the F1 group than that in the C1 group at T _ 2 time compared with the T _ (0) group, and the increase of HOMA-IR level at T _ (1) and T _ (0) level in the T _ (1) and T _ (0) groups were higher than that in the control group (P < 0.05). Compared with C1 group, ISI decreased the concentration of HOMA-IRN IL-6 TNF- 伪. Compared with F1 group, the level of blood glucose in F2 group was significantly lower than that in F1 group. The level of HOMA-IR in F2 group was significantly lower than that in C2 group. The level of Harris hip joint was significantly lower in the fourth group than that in the F1 group at T _ 1 T _ 2 time. The level of HOMA-IR in F2 group was significantly lower than that in C _ 2 group (P _ (0.05) .T _ (1) T _ (2) T _ 2) group was significantly lower than that in C _ 2 group (P 0.05). The postoperative score of F1 group was significantly higher than that of C1 group (P 0.05). Conclusion 1. The perioperative insulin resistance in obese patients undergoing total hip replacement was significantly higher than that in normal weight patients. The excellent and good rate of recovery of ganglion function was lower than that of normal body weight. Lumbar plexus block could reduce perioperative insulin resistance in obese patients undergoing total hip replacement. Perioperative inflammation in obese patients, This may be one of the mechanisms for reducing perioperative insulin resistance.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614.2

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