快速康复外科理念对肝部分切除患者围术期胰岛素抵抗及炎症反应的影响

发布时间：2018-08-18 13:19

【摘要】：目的探讨快速康复外科(FST)理念指导下对肝部分切除术患者围术期胰岛素抵抗和炎症反应的影响。方法选择择期行肝部分切除术的患者60例,按住院号分为FTS组和对照组。FST组应用FTS措施进行综合处理,而对照组采用传统方案治疗,比较两组麻醉相关指标:围术期麻醉维持期用药量,术后苏醒时间及术后镇痛效果;并于术前3 h(T1)、麻醉前(T2)、术毕(T3)、术后第1天(T4)和术后第3天(T5)分别抽取患者静脉血9m L,各3 m L测定空腹血糖和血清胰岛素浓度,并用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(HOMA-ISI)。另3 m L采用酶联免疫吸附试验(ELISA)检测白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)浓度。结果与对照组比较,FTS组术中麻醉维持期间,七氟醚、阿曲库铵、丙泊酚及舒芬太尼用量明显减少,术后苏醒时间更快,术后镇痛效果更好(P0.05)。与对照组比较,FTS组在T2时血糖明显升高,但T3时其血糖水平明显降低(P0.05)。与对照组比较,FTS组在T3、T4、T5时其胰岛素水平和IR明显降低,而ISI水平升高(P0.05);与对照组比较,FTS组在T3时IL-6、TNF-α浓度明显降低(P0.05)。结论FST理念应用于肝部分切除术患者能改善围术期胰岛素抵抗,并降低患者机体的炎症反应。
[Abstract]:Objective to investigate the effect of (FST) on perioperative insulin resistance and inflammation in patients undergoing partial hepatectomy. Methods A total of 60 patients undergoing partial hepatectomy were divided into FTS group and control group. FST group was treated with FTS, while the control group was treated with traditional regimen. The anaesthesis-related indexes of the two groups were compared: the amount of drugs used during the maintenance of anesthesia during perioperative period, the time of postoperative recovery and the effect of postoperative analgesia; Venous blood samples were taken 3 hours before operation (T1), before anesthesia (T2), after operation (T3), 1 day after operation (T4) and 3 days after operation (T5). Fasting blood glucose and serum insulin concentration were measured respectively. Insulin resistance index (HOMA-IR) and insulin sensitivity index (HOMA-ISI) were calculated by (HOMA). The concentration of interleukin-6 (IL-6) and tumor necrosis factor- 伪 (TNF- 伪) were detected by enzyme linked immunosorbent assay (ELISA). Results compared with the control group, the dosage of sevoflurane, atracurium, propofol and sufentanil in FTS group decreased significantly, the recovery time was faster and the analgesia effect was better (P0.05). Compared with the control group, the level of blood glucose in FTS group increased significantly at T2, but decreased significantly at T3 (P0.05). Compared with the control group, the levels of insulin and IR in T3T4T5 group were significantly lower than those in the control group (P0.05), while the level of ISI was higher in FTS group than in the control group (P0.05), and the concentration of IL-6 TNF- 伪 in T3T4T5 group was significantly lower than that in the control group (P0.05). Conclusion the application of FST in partial hepatectomy can improve the perioperative insulin resistance and reduce the inflammatory response of the patients.
【作者单位】：南昌大学第一附属医院麻醉科;南昌大学第二附属医院麻醉科;
【基金】：江西省科技计划项目(编号:20151BBG70189) 江西省卫生厅中医处课题项目(编号:2015A121)
【分类号】：R657.3

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