乌司他丁对食管癌手术后患者应激性高血糖的影响

Effect of ulinastatin on stress hyperglycemia in patients with esophageal cancer after thoracotomy

目的观察乌司他丁（UTI）对食管癌手术后患者应激性高血糖的影响。方法60例食管癌手术后确诊合并应激性高血糖的患者随机分为2组，其中对照组（C组，n=30）接受常规胰岛素降血糖治疗及其他综合治疗，联用UTI组（UTI组，n=30）在对照组治疗方法的基础上加用UTI。术后第1、3、5天检测空腹血糖（BG）、空腹胰岛素（INS）、肿瘤坏死因子-α（TNF-α）以及白细胞介素-6（IL-6）的水平，计算胰岛素敏感指数（ISI）。结果两组术后第1天各项指标差异无统计学意义（P〉0．05）。UTI组第3天TNF-α（48．27±13．92）μg/L、IL-6（172．38±19．82）μg／L、BG（7．48±1．72）mmol／L、INS（11．32±3．47）mU／L水平已呈下降趋势，ISI（4．37±0．35）渐升高（P〈0．05），第5天TNF-α（32．10±15．64）μg／L、IL-6（113．83±21．33）μg/L、BG（5．61±1．57）mmol／L、INS（8．48±3．63）mU／L、ISL（3．80±0．29）已恢复（P〈0．05）。C组相应指标各阶段恢复均慢于UTI组（P〈0．05）。且uTI组感染率（6．67％，2／30）较C组（30．00％，9／30）降低（P〈0．05）。结论联用UTI能较单用胰岛素更有效地控制食管癌手术后应激性高血糖。

Objective To evaluate the effect of ulinastatin （UTI） on stress hyperglycemia in pa- tients with esophageal cancer after thoracotomy. Methods Sixty patients who suffered from esophageal cancer and were diagnosed of combined stress hyperglycemia after thoracotomy were divided into two groups randomly. Both control group （group C,n =30） and UTI treatment group （group UTI,n =30） were given regular treatment with insulin and other comprehensive treatment. Group UTI was given UTI additionally. The morning fasting blood glucose （BG）, fasting insulin （INS）, tumor necrosis factor-a （TNF-a） and in- terleukin-6 （IL-6） levels and insulin sensitivity index （ISI） were measured at postoperative day （POD） 1, 3, and 5. Results At POD 1, the indexes had no significant difference between two groups （P 〉 0. 05）. At POD 3, the level of TNF-a （48.27±13.92）μg/L、IL-6（172.38±19.82）μg/L、BG（7.48±1.72）mmol/L, and INS （ 11.32 ±3.47） mU/L in group UTI was decreased, and ISI （ - 4. 37± 0. 35 ） was gradu-ally increased as compared with group C （ P 〈 0. 05 ）. The level of TNF-a （ 32. 10 ±15.64 ） μg/L, IL-6 （ 113. 83±21.33） μg/L, BG （5.61±1.57） mmol/L, INS （8.48±3. 63） mU/L and ISI - （3. 80±0. 29） in group UTI recoverd obviously at POD 5 （P 〈0. 05）. At each phase of group C, recovery of corresponding indexes was slower than in group UTI （P 〈0. 05）. Besides, infection rate was lower in group UTI （6. 67% , 2/30） than in group C （30. 00%, 9/30）（ P 〈 0. 05 ）. Conclusion The combined use of UTI with insulin can more effectively control the stress hyperglycemia after esophageal thoraeotomy than insulin used alone.