病人自控硬膜外镇痛对胃肠手术后糖代谢影响的临床研究

EFFECTS OF PATIENT CONTROLLED EPIDURAL ANALGESIA ON GLUCOSE METABOLISM OF PATIENTS AFTER GASTROINTESTINAL SURGERY

目的 :研究病人自控硬膜外镇痛 (PCEA)对胃肠手术后糖代谢的影响。方法 :择期胃肠手术病人 32例 ,A组 (1 5例 )术后肌注和 (或 )肛塞药物止痛 ,B组 (1 7例 )术后行PCEA。术前及术后第 1、3、6天 6时抽血检测空腹血糖及胰岛素。结果 :两组病人术前空腹血糖、胰岛素及胰岛素敏感性指数 (IAI)值无统计学差异 (P >0 .0 5 )。所有病人术后均出现空腹血糖升高、空腹胰岛素水平升高、IAI值下降 ,但B组较A组变化小 (P <0 .0 1～P <0 .0 0 1 )。A组中这种变化持续至术后第 6天仍未恢复(P <0 .0 5～P <0 .0 1 ) ,B组在术后第 6天空腹胰岛素及IAI已与术前无显著性差异。结论 :PCEA较传统镇痛方法能有效改善并缩短术后由于胰岛素敏感性下降而致的糖代谢紊乱时间 。

Objective: To investigate the effects of Patient controlled epidural analgesia(PCEA) on glucose metabolism of patients undergoing gastrointestinal surgery. Methods: 32 patients undergoing selective gastrointestinal surgery were assigned randomly to two groups: group A (n=15) undergoing postoperative analgesia as usual (eg. i.m. analgesic) , group B undergoing PCEA(n=17) . The fasting plasma concentrations of glucose (FBG) and insulin (FINS) were determined before operation and 1 day , 3 day, 6 day after opertion at 6 am. Ln (FBG -1 × FINS -1 ) (entitled IAI) was used to analyze insulin resistance. Results: FBG, FINS and IAI before operation had no significant difference between group A and B (P>0.05). After the operation, FBG and FINS inceased and IAI decreased in both groups. These changes were significantly weaker in group B compared with group A(P<0.01～P<0.001) after operation. The parameters in group A remained abnormal till six day after operation (P<0.05～P<0.01), but in group B, FINS and IAI were similar as those before operation on the sixth postoperative day. Conclusion: PCEA ameliorates and attenuates glucose metabolic disorder resulting from the decline in insulin sensitivity after operation.