氯诺昔康围术期镇痛对患者血糖、胰岛素和皮质醇的影响

Effects of lornoxicam on blood glucose, plasma insulin and cortisol in patients

目的观察氯诺昔康围术期镇痛对机体血糖、胰岛素和血浆皮质醇水平的影响。方法24例在硬膜外麻醉下行择期胆囊切除术病人,随机分为氯诺昔康组(L组):经硬膜外腔单次推注吗啡1.5 mg和新斯的明1 mg并复合静脉推注氯诺昔康镇痛;对照组(C组):经硬膜外腔单次推注吗啡1.5 mg和新斯的明1 mg镇痛。于术前(T1)、术毕(T2)、术后第1天(T3)、术后第2天(T4)和术后第3天(T5)测定血糖、胰岛素和血浆皮质醇浓度,视觉模拟评分法(VAS)作术后4、24和48 h的静止与活动时VAS评分。结果C组术后4 h、术后24 h静止或活动VAS评分明显高于L组(P<0.05)。C组术毕、术后第1天、术后第2天血浆皮质醇浓度与术前比明显升高(P<0.05或0.01),而L组血浆皮质醇浓度仅术毕时显著增高(P<0.05);L组术毕、术后第1天、术后第2天血糖、血浆胰岛素和血浆皮质醇水平均显著低于C组(P<0.05或0.01)。结论氯诺昔康应用于围术期镇痛,增强硬膜外吗啡的镇痛效果,有效地遏制机体的高代谢状态,减轻术后糖代谢紊乱。

Aim To investigate the effects of lornoxicam on blood glucose, plasma insulin and cortisol in patients after cholecystectomy. Methods Twenty-four ASA Ⅰ to Ⅱ patients under epidural anesthesia were randomly divided into two groups, Patients in group L received intravenous administration of lornoxicam while those in group C did not. The patients all were given morphine 1.5 mg and neostigmine 1 mg for pain relief which were injected into epidural space before incision. The levels of blood glucose, plasma insulin and cortisol were measured at five time points： before anesthesia, at the end of surgery, on the 1^st, 2^nd and 3^rd postoperative days, The VAS value were observed at the 4, 24 and 48 h postoperative hours. Results The VAS values at 4 h and 24 h postoperative hours were fewer in group L than those in group C. The levels of plasma cortisol increased significantly at the end of surgery, on the 1^st and 2^nd postoperative days （P 〈 0.05 or 0.01 ） in group C and only at the end of surgery in group L （P 〈 0.05 ）. Blood glucose, plasma insulin and cortisol at the end of surgery, on the 1^st and 2^nd postoperative days were much less in group L than those in group C （ P 〈 0.05 or 0.01 ）. Conclusion Lornoxicam may enhance the postoperative analgesic effects of morphine and alleviate the stress response to surgery and the disturbance of glucose metabolism.