腹部择期手术患者胰岛素抵抗临床观察

Clinical Observation of Insulin Resistance during Selective Abdominal Surgery

目的研究外科择期手术患者胰岛素抵抗(IR)的临床意义,探讨与IR的相关因素。方法选择腹部择期手术患者14例,分别检测患者术前1天、术中(手术开始后1小时)、术后24小时血浆肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血糖、胰岛素水平,利用稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数和胰岛素敏感指数(ISI)。结果术后血糖、胰岛素、IL-6、TNF-α水平较术前、术中均显著升高(P<0.001),术中IL-6水平亦显著高于术前(P=0.017),而术前与术中的血糖、血胰岛素、TNF-α水平差异无显著性(分别P=0.421,P=0.116,P=0.076)。术后HOMA-IR显著高于术前(P<0.001)。ISI与手术时间(r=-0.936、P<0.001)、术中出血量(r=-0.594、P=0.032)、术后TNF-α水平(r=-0.641、P=0.018)呈显著负相关。结论腹部择期手术患者存在IR。缩短手术时间、降低手术创伤强度、减少出血对减轻IR具有重要意义。

Objective To explore the clinical significance of insulin resistance （IR） during selective abdominal surgery. Methods Totally 14 patients （5 men and 9 women） underwent selective abdominal surgery were enrolled. Fasting blood glucose （ BG）, fasting plasma insulin （ INS）, plasma tumor necrosis factor-α （ TNF-α）, and interleukin-6 （IL-6） were tested on one day before operation, during operation, and 24 hours after surgery. Insulin resistance index （ HOMA-IR）, the index of insulin secretion （ HOMA-β）, and insulin sensitivity index （ISI） were calculated with Homeostasis Model Assessment （HOMA）. Results BG, INS, plasma TNF- α, and IL-6 were significantly different one day before surgery, during operation, and 24 hours after surgery （ P 〈0. 001 ）. While the level of IL-6 during operation was significantly higher than that before operation （ P = 0. 017）, the levels of BG, INS, and TNF-α between one day before operation and during operation were not significantly different （P = 0. 421, P = 0. 116, and P = 0. 076, respectively）. The HOMA-IR levels significantly increased 24 hours after surgery compared to that before operation （ P 〈 0. 001 ）. However, HOMA-β wasnot significantly different among three time points （P = 0. 103 ）. ISI was negatively correlated with the operation time （ r = -0. 936, P 〈0. 001 ）, perioperative bleeding （ r = -0. 594, P =0. 032）, and post-operative TNF-α （ r = - 0.641, P = 0.018 ）. Conclusions IR exists during selective abdominal operation. Shorter operation duration, milder surgery-related trauma, and less perioperative bleeding may reduce IR.