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山东大学学报(医学版)

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高乌甲素对围术期血糖、皮质醇、β-内啡肽的影响

迟永良1,2,苏帆2   

  1. 1.山东大学医学院, 济南 250012; 2. 山东中医药大学附属医院麻醉科, 济南 250012
  • 收稿日期:2007-12-25 修回日期:1900-01-01 出版日期:2008-03-16 发布日期:2008-03-16
  • 通讯作者: 迟永良

Effect of Lappaconitine on glucose, cortisol and β-Endorphine during surgeries

CHI Yong-liang1,2,SU Fan2   

  1. 1. School of Medicine, Shandong University, Jinan 250012, China;2. Department of Anaesthesia, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250012, China
  • Received:2007-12-25 Revised:1900-01-01 Online:2008-03-16 Published:2008-03-16
  • Contact: CHI Yong-liang

摘要: 目的观察围术期使用高乌甲素(Lappaconitine)对手术患者血糖、皮质醇、血浆β内啡肽的影响,并探讨其机制。方法选取腰椎间盘突出、腰椎管狭窄、腰椎滑脱等需手术患者45例,所有患者均采用全凭静脉麻醉,随机分为三组,每组15例。高乌甲素组:于麻醉开始前30min静脉滴注高乌甲素8mg,术中电子泵持续背景输注量为0.28g/mL,术毕给予负荷剂量8mg,患者自控静脉镇痛(PCIA)高乌甲素总用量为48mg;曲吗多组:于麻醉开始前30min静脉滴注曲吗多100mg,术中电子泵持续背景输注量为8g/mL,术毕给予负荷剂量100mg,PCIA曲吗多总用量为1g;常规麻醉组:常规麻醉,术后按需复合使用盐酸哌替啶(50mg/次)与氟哌利多(2.5mg/次)镇痛。分别于术前、术毕即刻、术后第1d和术后第2d晨抽取静脉血,测定血糖、皮质醇、β内啡肽水平。结果术前三组各观察项无明显差异(P>0.05)。血糖项:高乌甲素组术后第1d、曲吗多组术毕即刻、术后第1d较术前明显升高(P<0.05);常规麻醉组术后各时点较术前明显升高(P<0.05),与高乌甲素组比较有明显差异(P<0.05)。皮质醇项:高乌甲素组各时点无明显变化;曲吗多组术毕即刻、术后第1d较术前明显升高(P<0.05),与高乌甲素组比较,差异有统计学意义(P<0.05);常规麻醉组术后各时点较术前明显升高(P<0.05),与高乌甲素组、曲吗多组比较,差异有统计学意义(P<0.05)。β-内啡肽项:高乌甲素组各时点无明显变化;曲吗多组术后各时点较术前明显升高(P<0.05);常规麻醉组术后各时点较术前明显升高(P<0.05或P<0.01),与高乌甲素组比较,差异有统计学意义(P<0.05或P<0.01)。结论高乌甲素可以降低围术期患者血糖、皮质醇、β-内啡肽水平,抑制围术期应激反应,其机制可能与其镇痛抗炎作用有关。

Abstract: To explore the effect of Lapppaconitine on glucose, cortisol andβendorphine in surgeries. Methods 45 patients suffering from nucleus pulposus of the lumbar, lumbar spinal stenosis, and lumbar spondylolisthesis were randomly divided into 3 groups(n=15). The group of Lapppaconitine: 8mg Lappaconitine was intravenously infused 30?min before total intravenous anaesthesia(TIVA) and kept in a speed of 0.28mg/mL during the operations, and then 8mg Lappaconitine was given after the operations, and PCIA(patientcontrolled intravenous analgesia) started as soon as the patients woke up from anaesthesia. The total dose of lappaconitine was 48mg. The group of Tramadol: 100mg Tramadol was intravenously infused 30min before TIVA and kept in a speed of 8?mg/mL during the operations. PCIA started as soon as the patients woke up from anaesthesia. Tramadol(100mg) was infused before PCIA(the total dose of Tramadol was 1g). The control group: TIVA without either Lappaconitine or Tramadol during the operations or PCIA was performed on each patient. After operation, pethidine(50mg) and droperidol(2.5mg)were used to relieve the pain. The levels of glucose, cortisol and β-endorphine were determined at 30?min before anaethesia, the end of surgery, 24h and 48h after operations. ResultsThere were no significant differences before surgery in each group(P>0.05). The norm of glucose: compared with that before surgery, the level of glucose was significantly increased just at the end of surgery and 24h after surgery in group Tramadol(P<0.05) and at 24h after surgery in group Lapppaconitine, also the level of glucose was significantly increased in the control group(P<0.05). There were significant differences between the control group and the Lapppaconitine group (P<0.05). The norm of cortisol: there were significant differences between the group of Lapppaconitine and the group of Tramadol just at the end of surgery and 24?h after surgery(P<0.05), also there were significant differences between the control group and the Lapppaconitine group(P<0.05). The norm of plasma βendorphine: there were significant differences between the tramadol group and the Lapppaconitine group(P<0.05), between the pre- and post-operative control groups(P<0.05 or P<0.01), and between the postoperative control group and the Lapppaconitine group(P<0.05 or P<0.01). ConclusionLappaconitine can decrease the levels of glucose, cortisol and β-endorphine.

Key words: Lappaconitine, Stress, Hypothalamuspituitaryadrenal cortex system

中图分类号: 

  • R971.2
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