术后镇痛对创伤患者围术期细胞因子和胰岛素抵抗的影响研究

Postoperative Analgesia Effect on Trauma Patients Perioperative Cytokine and Insulin Resistance during Operation

研究术后镇痛对创伤患者围术期细胞因子IL-6、TNF-α和胰岛素抵抗(IR)的影响。选取60例患者,随机分为两组,A组患者应用一次性术后镇痛泵,加入舒芬太尼2.5μg/kg+盐酸托烷司琼4mg,用生理盐水稀释至100ml,2ml/h持续注入。B组患者为术后根据临床需要临时给予杜冷丁每次50mg^100mg肌肉注射,每日不超过3次。发现两组患者术后镇痛效果比较,A组患者舒适程度要优于B组,随访患者无与药物相关的不良反应。术后两组患者血浆IL-6、TNF-α水平均开始升高,术后12h左右达峰值,24h后开始回落,但均明显高于术前。血糖和血胰岛素值也在术后升高,术后24h左右达峰值,之后逐渐回落。ISI在术后开始降低,术后24h降到最低,之后逐渐回升,但均低于术前,说明IL-6、TNF-α水平升高与创伤后胰岛素抵抗有相关性。A组患者术后12h、24h、36h、48h的血糖、血胰岛素、IL-6、TNF-α水平与B组比较明显降低,而且术后48h基本可以恢复术前水平。应用舒芬太尼术后镇痛可以通过抑制血浆中IL-6和TNF-α水平,从而抑制围术期胰岛素抵抗,降低应激反应,从而达到减轻免疫抑制和降低或缩短IR时间的目的。

Study on postoperative analgesia on patients with trauma perioperative cytokine IL-6,TNF-α and insulin resistance （IR） effect.60 cases were selected,and were randomly divided into two groups：A group and B group.In group A,patients for postoperative analgesia pump application of disposable,adding Sufentanil 2.5μg/kg＋4mg tropisetron,diluted with 0.9％NaCl to 100ml,2ml/h continuous injection.Patients in group B after operation according to clinical need temporary given pethidine intramuscular injection every 50mg～ 100mg,not more than 3 times daily.Comparison of analgesic effect in patients of two groups,group A patients comfortable extent than group B,no adverse reaction and drug related follow up of patients.After two groups of patients with plasma IL-6,TNF-α levels were initially elevated,postoperative 12h reached peak,24h began to fall,but were higher than that before operation.Blood glucose and insulin values were also elevated after operation,postoperative 24h and reached the peak,then gradually decline.ISI began to decrease after operation,postoperative 24h to a minimum,and then gradually recovered,but lower than that before operation,indicating that the elevated IL-6,TNF-α level correlated with insulin resistance after trauma.Patients in group A after 12h,24h,36h,48h of blood glucose,blood insulin,IL-6,TNF-α levels compared with the B group decreased significantly,and 48h after the operation,the basic level can be recovered to the preoperative level.Application of Sufentanil for postoperative analgesia can inhibit the plasma IL-6 and TNF-α levels,thereby inhibiting the perioperative insulin resistance,decreasing stress reaction,so as to achieve reduced immunosuppression and reduce or shorten the time to IR.