不同麻醉镇痛方式对胃癌患者术后胰岛素抵抗的影响

Effects of Different Anesthesia and Analgesia Methods on Insulin Resistance in Patients with Gastric Cancer after Operation

摘要: 目的：评价不同麻醉镇痛方式对胃癌患者术后恢复的影响，并探讨对术后胰岛素抵抗的影响及其作用机制。方法：60例胃癌患者随机分为两组，每组30例。一组为常规全麻组，术后采用静脉自控镇痛(PCIA)；另一组为全身麻醉复合硬膜外麻醉组，术后应用硬膜外自控镇痛(PCEA)。分别比较两组患者的麻醉术后首次排气时间、术后首次下地活动时间、住院天数、疼痛评分(VAS)、胰岛素抵抗指数(IRI)和急性反应蛋白(CRP)。结果：1) 两组患者一般资料比较，差异无统计学意义(P > 0.05)；2) PCEA组患者术后VAS明显低于PICA组，差异有统计学意义(P < 0.05)；3) PCEA组患者术后IRI明显低于PCIA组，差异有统计学意义(P < 0.05)，PCEA组患者术后CRP计数低于PCIA组，差异有统计学意义(P < 0.05)；4) PCEA组患者术后首次排气时间、术后首次下地活动时间及住院天数显著短于PCIA组，差异有统计学意义(P < 0.05)，术后并发症两组比较差异无统计学意义(P > 0.05)。结论：全身麻醉复合硬膜外麻醉应用硬膜外镇痛泵的方式能明显减轻胃癌患者术后疼痛感，有效减轻全身炎症反应，降低术后胰岛素抵抗，缩短住院时间，有利于患者术后康复。

Abstract: Objective: To evaluate the effects of different anesthesia and analgesia methods on postoperative recovery of patients with gastric cancer, and to explore the effects on insulin resistance and its mechanism. Methods: Sixty patients with gastric cancer were randomly divided into two groups, thirty patients in each group. The first group was treated with general anesthesia, patients adopted patient-controlled intravenous analgesia (PCIA) after surgery; the other group was general anesthesia combined with epidural anesthesia, postoperative patients received continuous patient-controlled epidural analgesia (PCEA). Compare the first postoperative exhaust time and off-bed ambulation time, pain score (VAS), insulin resistance index (IRI) and acute reactive protein (CRP) in 2 groups after anesthesia, and record the hospital stay, postoperative complications and other conditions. Results: 1) There was no statistical significance in general data between the 2 groups (P > 0.05). 2) The postoperative VAS in PCEA group was significantly lower than that in PCIA group, with statistical significances (P < 0.05). 3) The postoperative IRI and CRP in the PCEA group were significantly lower than those in PCIA, all with statistical significances (P < 0.05). 4) The length of first postoperative exhaust time and off-bed ambulation time and hospital stay in PCEA group were significantly lower than those in PCIA group, all with statistical significances (P < 0.05), while there was no significant difference in postoperative complications among the two groups (P > 0.05). Conclusion: General anesthesia combined with epidural anesthesia and analgesia can shorten the first postoperative exhaust time and off-bed ambulation time obviously, reduce systemic inflammatory reaction and insulin resistance effectively, shorten the length of hospital stay and reduce hospitalization costs, and help to accelerate recovery of postoperative patients with gastric cancer.