丙泊酚对伴2型糖尿病胆囊炎行LC患者心肌功能和IR及炎症因子水平的影响

Effect of Propofol Applied in LC on Cardiac Function, IR and Levels of Inflammatory Factors in Patients of Cholecystitis Complicated with T2DM

【目的】探讨胆囊炎伴2型糖尿病（T2DM）患者腹腔镜胆囊切除术（LC）中应用丙泊酚对其心肌功能、胰岛素抵抗（IR）及炎症因子水平的影响。【方法】104例行ICc的胆囊炎伴T2DM患者随机分成两组，各52例。观察组（A组）予以芬太尼＋丙泊酚，对照组（B组）予以芬太尼十异氟醚麻醉维持。比较两组患者麻醉前（T0）、麻醉后（T0）、建立气腹后5min（T2）、手术结束即刻（T3）血流动力学指标[平均动脉压（MAP）、心率（HR），]变化情况，手术前后胰岛素抵抗指数（HOMA-IR）、炎症因子[肿瘤坏死因子一d（TNF-α）、C反应蛋白（CRP）]及心肌功能指标[血清肌酸激酶同工酶（CK—MB）、心肌肌钙蛋白I（cTnI）]结果差异，分析其术后恢复情况。【结果】①T1时，两组MAP、HR水平均较T0时明显降低（P〈0．05）；但各时间点组间比较差异均无显著性（P〉0．05）。②手术后，两组H（）M～1R水平及炎症因子（TNFmd、CRP）检测结果均较手术前明显提高，且B组〉A组（P均〈0．05）。A组CK～MB、cTnl水平较手术前无明显改变（P〉0．05），B组上述指标则较手术前明显提高（P〈0．05）。③A组自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间均明显短于B组（P均〈0．05）。【结论】将丙泊酚联合芬太尼麻醉方案用于胆囊炎伴T2DM患者的I，c术中，对改善其IR、调节手术创伤应激反应、保护心血管等具有积极意义。

[Objective]To explore the effect of propofol applied in I.C on cardiac function, IR and levels of inflamma tory factors in patients of cholecystitis complicated with T2DM. [Methods]One hundred and four patients of cholccystitis complicated with T2DM treated by LC were randomized into study group（A） and control group（B）, 52 in each group. The group A was treated with propofol while the group ]3 was treated with isoflurane maintenance anesthesia. The changes of hemodynamic parameters MAP, HR were compared between the two groups before anesthesia （T0）, after anesthesia （T1）, 5min after establishment of pneumoperitoneum （T2） and immediate after the surgery （T：~）. The differences in IR index, inflammatory factors TNF-α, CRP and myocardial function indexes CK-MB, cTnI before and after treatment were recorded, and postoperative recovery was analyzed.[Resuhs]① At T1, MAP and HR of both groups were significantly lower than those at To （ P〈0.05） but there were no significant differences between groups at different time points （ P〉 0.05）. ②After surgery, IR and levels of TNF-α, CRP were significantly higher than those before operation, and those in the group A were higher than those of the group B （ P〈0.05）. There were no significant changes of CK-MB and cTnI in group A, compared with those before operation （ P〈0.05） while those in group B were significantly higher than those before operation （ P〈0.05）. ③The time of spontaneous breathing recovery, duration of eye opening, extubation time and time of directive force recovery in the group A were significantly shorter than those of the group B （ P〈0.05）. [Conclusion] The application of propofol combined with fentanyl anesthesia in I.C of patients with choleeystfiis complicat ed with T2DM mellitus is of positive significance in improving the state of IR, regulating the surgical trauma stress re sponse and protecting cardiovascular system.