不同创伤程度手术对围手术期患者胰岛素抵抗等指标的影响

The effects of different degrees of surgical trauma on insulin resistance in perioperative patients

目的探讨不同创伤程度手术对围手术期患者胰岛素抵抗(insulin resistence,IR)等指标的影响,了解围手术期IR与手术创伤程度的关系。方法 2016年3月—2016年12月唐山市开滦总医院、饶阳县医院及张北县医院择期行肝胆、胰腺手术患者100例(其中肝脏手术30例,胆囊手术38例,胰腺手术32例),根据手术创伤程度评分(OSS评分)将100例患者分为轻度创伤组(36例)、中度创伤组(33例)、重度创伤组(31例),分别于患者麻醉前(T_0)、术后拔出气管导管时(T_1)、术后第1天空腹(T_2)及术后第3天空腹(T_3)检测空腹血浆葡萄糖(FPG)、血浆胰岛素(FINS),稳态模式评估法(HOMA-IR)计算IR指数,定量胰岛素敏感性检测指数法(QUICKI)测定胰岛素敏感性指数(ISI),并计算不同时段△ISI变化情况。结果 T_1、T_2及T_3,3组患者血浆FPG水平、FINS水平、IR指数、ISI比较,差异均有统计学意义(P<0.05),且重度创伤组血浆FPG水平、FINS水平、IR指数最高,ISI最低;同组患者,T_0、T_1、T_2及T_3血浆FPG水平、FINS水平、IR指数、ISI比较,差异均有统计学意义(P<0.05),且T_2血浆FPG水平、FINS水平、IR指数最高,ISI最低。3组患者同时段△ISI值比较,差异均有统计学意义(P<0.05),且重度创伤组最高;同组患者不同时段△ISI值比较,差异均有统计学意义(P<0.05),且△ISI_2最高;Pearson相关分析显示,围手术期IR指数与OSS评分呈正相关(r=0.938,P<0.001)。结论不同手术创伤程度患者不同时间有不同程度的血浆FPG水平、FINS水平、IR指数、ISI的变化,以术后第1天变化显著。IR出现时间早且随着手术创伤程度的加深而增强,随着时间及患者恢复逐渐下降。IR与手术创伤程度密切相关。

Objective To observe the effects of different degrees of surgical trauma on insulin resistance(IR)in perioperative patients and to understand the relationship between perioperative IR and the degrees of surgical trauma.Methods Totally 100 patients with hepatobiliary and pancreatic surgeries were enrolled from Mar.2016 to Dec.2016 in Kailuan General Hospital of Tangshan,Raoyang Hospital and Zhangbei Hospital including 30 liver surgeries,38 gallbladder surgeries,and 32 pancreatic surgeries.The 100 patients were divided into mild trauma group(n=36),moderate trauma group(n=33),and severe trauma group(n=31)according to the degrees of surgical trauma score(OSS).Fasting plasma glucose(FPG)and fasting plasma insulin(FINS)were detected before anesthesia(T 0),tracheal extubation after operation(T 1),the first fasting(T 2)day and the third fasting day after operation(T3),respectively.The IR index was calculated by homeostasis model assessment(HOMA-IR)and insulin sensitivity index(ISI)was calculated by quantitative insulin sensitivity test index(QUICKI).The different time interval△ISI was calculated.Results The levels of FPG,FINS,IR index and ISI in the three groups in T 1,T 2 and T 3 were statistically significant(P<0.05),and the FPG,FINS levels and IR index were highest and ISI were lowest in severe trauma group.The levels of FPG,FINS,IR index,ISI in T 0,T 1,T 2 and T 3 in the same group were statistically significant(P<0.05),and the FPG,FINS and IR index were highest and ISI was lowest in T 2.The△ISI in three groups at the same time was statistically significantly different(P<0.05),and was highest in the severe trauma group.The△ISI in the same group at different times was statistically significantly different(P<0.05),and△ISI 2 was highest.Pearson correlation analysis showed that IR index in perioperative period was positively correlated with OSS(r=0.938,P<0.001).Conclusion Different degrees of surgical trauma patients have different levels of FPG,FINS,IR index and ISI changes at different times,which are most significant on the first day after surgeries.IR appears earlier and increases with the degrees of surgical trauma,and gradually decreases with the time of patients recovery.IR is closely related to the degrees of surgical trauma.