不同麻醉和术后镇痛方式对中老年胸科手术后胰岛素抵抗的影响

目的：探讨不同麻醉和术后镇痛方式对中老年胸科手术后胰岛素抵抗的影响。方法：中老年胸科手术患者80例随机分为治疗组与对照组各40例，两组都采用开胸手术治疗，于手术结束前30min硬膜外腔给予镇痛，治疗组采用舒芬太尼镇痛，对照组采用地佐辛镇痛。结果：两组镇痛后2h与镇痛后24h的HR和MVP对比差异明显（P〈0．05），同时对照组不同时间点的组内对比差异明显（P〈0．05），治疗组组内对比无明显差异。治疗组在镇痛后2h与镇痛后24h的VAS评分都明显少于对照组（P〈0．05），Ramsay评分治疗组高于对照组（P〈0．05）。治疗组组内不同时间点胰岛素含量和胰岛素敏感性对比无明显差异，而对照组对比差异明显（P〈0．05），同时镇痛后组间对比也有明显差异（P〈0．05）。结论：相对于地佐辛，舒芬太尼用于中老年胸科手术术后疼痛镇痛效果良好，能有效地抑制胰岛素抵抗与应激反应的发生，有很好的应用效果。

Effect of Different Anesthesia and Postoperative Analgesia in Elderly Insulin Resistance after Thoracic Surgery

Objective： To explore the different anesthesia and postoperative analgesia affect in elderly thoracic surgery on insulin resistance. Methods： A total 80 elderly patients undergoing thoracic surgery were randomly divided into treatment group and control group, both groups have adopted thoracic surgery, 30min before the end of surgery each patient were given epidural analgesia, the treatment group used sufentanil for postoperative analgesia, and the control group used dezocine for postoperative analgesia. Results： 2h and 24h after analgesia, compared with control group, HR and MVP in treatment group was significantly differently （P 〈0.05）, while in control group, the HR and MVP at different time points was significant differently （P 〈0.05）. 2h and 24h after analgesia, compare with treatment group, the VAS scores were significantly lower than the control group （P 〈0.05）, and Ramasy scores in treatment group was higher than control group. In the control group at different time points, insulin levels and insulin sensitivity was significant differently（P 〈0.05）, but in the treatment group was not significant differences, while the indicator of analgesia were significant differently between two groups （P 〈0.05）. Conclusion： Compared to dezocine, sufentanil provide better postoperative analgesic in elderly thoracic surgery postoperative pain analgesic. Sufentanil can also effectively inhibit the insulin resistance and stress reactions, and have a good application in clinical.