地佐辛超前镇痛对腹腔镜直肠癌根治术患者围术期胰岛素抵抗的影响

摘要

目的研究地佐辛超前镇痛对腹腔镜直肠癌根治术患者围术期胰岛素抵抗（IR）的影响。方法选取2014年4月1日至2015年4月1日择期行腹腔镜直肠癌根治术患者40例，采用全身麻醉方法，按随机数字表法随机分为研究组和对照组，每组20例。40例患者均对该研究知情，并自愿参加该研究。研究组于麻醉前15 min静脉注射地佐辛0.1 mg/kg，对照组于麻醉前15 min静脉注射同等容量生理盐水。于入手术室时，手术开始后1 h，手术结束后即刻，术后1、2、3 d清晨7：00采集患者外周静脉血检测空腹血糖、血清胰岛素及C肽水平，同时记录心率（HR）、平均动脉压等。结果两组患者围术期血流动力学稳定，组间及组内比较，差异均无统计学意义（P＞0.05）。研究组患者血糖较术前无明显变化，差异无统计学意义（P＞0.05），血清胰岛素、C肽仅在手术结束后即刻较术前升高，差异有统计学意义（P<0.05）；对照组患者各时间点血糖、血清胰岛素、C肽均较术前升高，且与研究组比较，差异均有统计学意义（P<0.05）。研究组胰岛素敏感性与术前比较，仅在手术结束后即刻降低，而对照组各时间点胰岛素敏感性均较术前降低，且与研究组比较，差异均有统计学意义（P<0.05）。研究组患者伤口感染发生率低于对照组，差异有统计学意义（χ2=7.04，P<0.05）。结论地佐辛超前镇痛能有效抑制IR，降低患者术后伤口感染发生率。%Objective To study the influence of dezocine preemptive analgesia on perioperative insulin resistance in the patients with laparoscopic radical rectectomy of rectal cancer. Methods Forty patients undergoing elective laparoscopic radical rectectomy of rectal cancer in our hospital from April 1,2014 to April 1,2015 were chosen for conducting general anesthesia and di-vided into the research group(D,n=20) and the control group(C,n=20) according to the random number table method. The patients were informed and voluntarily participate in this research. The research group were intravenously injected with dezocine 0.1 mg/kg at 15min before anesthesia induction ,while the control group with the equal volume of normal saline. The peripheral venous blood was collected at the entering the operating room,1 h after operation,instantly after the end of operation,at morning 7:00 a.m. on postop-erative 1,2 3 d. The fasting blood sugar,serum insulin,C peptide levels were detected,meanwhile the heart rate(HR),mean arterial pressure at different time points were recorded. Results The hemodynamics in the two groups was stable during the perioperative period,there were no statistical differences between inter-group and between intra-group(P>0.05). The blood sugar level after opera-tion in the research group had no obvious change compared with before operation ,the difference was not statistically significant (P>0.05);but serum insulin and C-peptide levels instantly after the end of operation was elevated compared with before operation ,the difference was statistically significant(P<0.05);the blood sugar,serum insulin C-peptide at various time points in the control group were increased compared with before operation ,moreover which showed the statistical differences compared with the research group (P<0.05). The insulin sensitivity in the research group was only decreased instantly after operation compared with before operation , while which at each time point in the control group was decreased compared with before operation ,and showed the statistical differ-ence compared with the research group(χ2=7.04,P<0.05). Conclusion The dezocine preemptive analgesia can effectively inhibit the insulin resistance and reduce the occurrence rate of postoperative infection.