电针对膝关节置换术患者胰岛素抵抗的影响
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摘要
目的:在腰硬联合阻滞麻醉和术后硬膜外镇痛基础上,探究电针对膝关节置换术后胰岛素抵抗的改善作用。方法:将80例有胰岛素抵抗但血糖正常患者随机分为观察组和对照组,每组40例。两组患者均择期行腰硬联合阻滞麻醉和术后硬膜外镇痛下膝关节置换术。观察组在此基础上在术中持续和术后1个月内行电针治疗,穴取合谷、气海、中脘、脾俞、肾俞等,隔日1次,治疗1个月;对照组不予电针处理。记录两组术前30 min(T_0)、手术结束即刻(T_1)、术后1 d(T_2)、3 d(T_3)、7 d(T_4)和1个月(T_5)的空腹血糖、空腹胰岛素,并计算胰岛素抵抗指数。结果:与T_0比较,对照组在T_1、T_3、T_4、T_5和观察组在T_1、T_4、T_5时间点胰岛素抵抗指数低(均P<0.05);与对照组同时间点比较,观察组T_1和T_5时间点胰岛素抵抗指数明显降低(均P<0.05),且低于胰岛素抵抗标准。结论:腰硬联合阻滞麻醉和术后硬膜外镇痛对胰岛素抵抗有短期改善作用,联合电针治疗胰岛素抵抗改善更明显,且影响时间更长。
Objective To explore the effect of electroacupuncture on the improvement of insulin resistance after knee joint replacement based on the combined spinal and epidural anesthesia and postoperative epidural analgesia.Methods Eighty patients with insulin resistance but normal blood glucose were randomly divided into a control group and an observation group,40 cases in each group.Both groups of patients underwent combined spinal and epidural anesthesia and postoperative epidural analgesia for knee arthroplasty.On the basis of the treatment,electroacupuncture(EA)was applied during the operation and within 1 month after the operation in the observation group,and EA was used at Hegu(LI 4),Qihai(CV 6),Zhongwan(CV 12),Pishu(BL 20),Shenshu(BL 23),etc.once every other day.The control group was not treated with electroacupuncture.Fasting blood glucose and fasting insulin were recorded 30 min before surgery(T_0),immediately(T_1),1 d(T_2),3 d(T_3),7 d(T_4)and 1 month(T_5)after surgery,and the insulin resistance(IR)index was calculated.Results Compared with those at T_0 time point,the IR index of the control group at T_1,T_3,T_4 and T_5 time points and the observation group at T_1,T_4,T_5 time points were lower(all P<0.05).Compared with the control group at the same time point,the IR index of the T_1 and T_5 time points in the observation group was significantly lower(both P<0.05),and it was lower than the insulin resistance standard.Conclusion Combined spinal and epidural anesthesia and postoperative epidural analgesia can improve short-term insulin resistance.Combined with EA,the improvement of insulin resistance is more obviously and longer.
Objective To explore the effect of electroacupuncture on the improvement of insulin resistance after knee joint replacement based on the combined spinal and epidural anesthesia and postoperative epidural analgesia.Methods Eighty patients with insulin resistance but normal blood glucose were randomly divided into a control group and an observation group,40 cases in each group.Both groups of patients underwent combined spinal and epidural anesthesia and postoperative epidural analgesia for knee arthroplasty.On the basis of the treatment,electroacupuncture(EA)was applied during the operation and within 1 month after the operation in the observation group,and EA was used at Hegu(LI 4),Qihai(CV 6),Zhongwan(CV 12),Pishu(BL 20),Shenshu(BL 23),etc.once every other day.The control group was not treated with electroacupuncture.Fasting blood glucose and fasting insulin were recorded 30 min before surgery(T_0),immediately(T_1),1 d(T_2),3 d(T_3),7 d(T_4)and 1 month(T_5)after surgery,and the insulin resistance(IR)index was calculated.Results Compared with those at T_0 time point,the IR index of the control group at T_1,T_3,T_4 and T_5 time points and the observation group at T_1,T_4,T_5 time points were lower(all P<0.05).Compared with the control group at the same time point,the IR index of the T_1 and T_5 time points in the observation group was significantly lower(both P<0.05),and it was lower than the insulin resistance standard.Conclusion Combined spinal and epidural anesthesia and postoperative epidural analgesia can improve short-term insulin resistance.Combined with EA,the improvement of insulin resistance is more obviously and longer.
引文
[1]Novo G,Manno G,Russo R,et al.Impact of insulin resistance on cardiac and vascular function[J].Int J Cardiol,2016,221:1095-1099.
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[3]Lugli AK,Donatelli F,Schricker T,et al.Epidural analgesia enhances the postoperative anabolic effect of amino acids in diabetes mellitus type 2 patients undergoing colon surgery[J].Anesthesiology,2008,108(6):1093-1099.
[4]刘美君,刘志诚,徐斌.针灸治疗2型糖尿病640例临床疗效观察[J].中华中医药杂志,2015,30(12):4531-4533.
[5]Burness R,Horne G,Purdie G.Albumin levels and mortality in patients with hip fractures[J].N Z Med J,1996,109(1016):56-57.
[6]郭小文,吕晨,郑晖,等.糖耐量减低和正常老年患者全膝置换术后胰岛素抵抗状况的比较研究[J].浙江医学,2015,37(15):1288-1290,1312.
[7]郭小文,陶涛,吕晨,等.两种不同麻醉和镇痛方法对糖耐量减低的老年高血压患者全膝置换术后糖代谢的影响[J].浙江医学,2016,38(2):112-116.
[8]Wolf AR,Eyres RL,Laussen PC,et al.Effect of extradural analgesia on stress responses to abdominal surgery in infants[J].Br J Anaesth,1993,70(6):654-606.
[9]Donatelli F,Vavassori A,Bonfanti S,et al.Epidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only[J].Anesth Analg,2007,104(6):1587-1593.
[10]蔡辉,袁爱红,魏群利.针灸对肥胖2型糖尿病“脂肪-胰岛”轴的调节作用[J].中国中医急症,2009,18(7):1043-1044.
[11]康钦凌.平衡针灸降糖穴治疗2型糖尿病临床研究[J].亚太传统医药,2015,11(24):89-90.
[12]陈婷,杨春,陶涛,等.电针联合体针治疗2型糖尿病100例[J].中国针灸,2017,37(12):1285-1286.
[13]李强,徐芬,梁凤霞,等.“标本配穴”电针对胰岛素抵抗大鼠股四头肌线粒体超微结构和生物合成功能的影响[J].中国针灸,2014,34(6):578-582.
[14]胡啸玲,周忠群,周志刚,等.电针麻醉方法对大白鼠外伤疼痛IL-2、sIL-2R、IFN-γ的影响[J].现代预防医学,2011,38(10):1922-1923,1932.
[15]王晓惠,吴学磊,金平林,等.电针麻醉用于妇科手术效果观察[J].实用中医药杂志,2012,28(1):33-33.
[2]Delmi M,Rapin CH,Bengoa JM,et al.Dietary supplementation in elderly patients with fractured neck of the femur[J].Lancet,1990,335(8696):1013-1016.
[3]Lugli AK,Donatelli F,Schricker T,et al.Epidural analgesia enhances the postoperative anabolic effect of amino acids in diabetes mellitus type 2 patients undergoing colon surgery[J].Anesthesiology,2008,108(6):1093-1099.
[4]刘美君,刘志诚,徐斌.针灸治疗2型糖尿病640例临床疗效观察[J].中华中医药杂志,2015,30(12):4531-4533.
[5]Burness R,Horne G,Purdie G.Albumin levels and mortality in patients with hip fractures[J].N Z Med J,1996,109(1016):56-57.
[6]郭小文,吕晨,郑晖,等.糖耐量减低和正常老年患者全膝置换术后胰岛素抵抗状况的比较研究[J].浙江医学,2015,37(15):1288-1290,1312.
[7]郭小文,陶涛,吕晨,等.两种不同麻醉和镇痛方法对糖耐量减低的老年高血压患者全膝置换术后糖代谢的影响[J].浙江医学,2016,38(2):112-116.
[8]Wolf AR,Eyres RL,Laussen PC,et al.Effect of extradural analgesia on stress responses to abdominal surgery in infants[J].Br J Anaesth,1993,70(6):654-606.
[9]Donatelli F,Vavassori A,Bonfanti S,et al.Epidural anesthesia and analgesia decrease the postoperative incidence of insulin resistance in preoperative insulin-resistant subjects only[J].Anesth Analg,2007,104(6):1587-1593.
[10]蔡辉,袁爱红,魏群利.针灸对肥胖2型糖尿病“脂肪-胰岛”轴的调节作用[J].中国中医急症,2009,18(7):1043-1044.
[11]康钦凌.平衡针灸降糖穴治疗2型糖尿病临床研究[J].亚太传统医药,2015,11(24):89-90.
[12]陈婷,杨春,陶涛,等.电针联合体针治疗2型糖尿病100例[J].中国针灸,2017,37(12):1285-1286.
[13]李强,徐芬,梁凤霞,等.“标本配穴”电针对胰岛素抵抗大鼠股四头肌线粒体超微结构和生物合成功能的影响[J].中国针灸,2014,34(6):578-582.
[14]胡啸玲,周忠群,周志刚,等.电针麻醉方法对大白鼠外伤疼痛IL-2、sIL-2R、IFN-γ的影响[J].现代预防医学,2011,38(10):1922-1923,1932.
[15]王晓惠,吴学磊,金平林,等.电针麻醉用于妇科手术效果观察[J].实用中医药杂志,2012,28(1):33-33.