舒芬太尼与芬太尼对胆囊切除手术患者血糖和胰岛素代谢组学的影响

发布时间：2018-04-30 07:58

本文选题：舒芬太尼 + 血糖　；参考：《临床麻醉学杂志》2017年12期

【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(P0.05)。术后2h舒芬太尼组胰岛素浓度明显低于芬太尼组(P0.05)。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。
[Abstract]:Objective to compare the effects of sufentanil and fentanyl anesthesia on blood glucose and insulin levels in patients undergoing laparoscopic cholecystectomy. Methods from April 2015 to October 2016, 60 patients (37 males and 23 females) undergoing laparoscopic cholecystectomy were enrolled in this study. They were randomly divided into sufentanil group and fentanyl group with 30 cases in each group. Blood glucose and insulin concentration were measured before anesthesia, 5 minutes after intubation, intraoperative 40min and 2 hours after operation. Insulin metabolism was analyzed at 2 hours after operation. Results 40min and sufentanil 2 hours after intubation were significantly lower than those in fentanyl group (P 0.05). The insulin concentration in sufentanil group was significantly lower than that in fentanyl group at 2 h postoperatively. Metabonomics analysis showed that in positive ion mode, two groups of patients could be classified according to serum metabolites 2 hours after operation by corrected partial least squares discriminant analysis, and the spectrum of serum metabolites of the two drugs was obviously different. Five biomarkers closely related to blood glucose and insulin were found. Conclusion sufentanil has little effect on blood glucose and insulin and is more suitable for anesthesia in patients undergoing cholecystectomy. The mechanism of sufentanil may be closely related to the different effects of two drugs on glucose metabolism and insulin metabolism.
【作者单位】：齐齐哈尔医学院第二附属医院麻醉科;
【分类号】：R614

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