摘要
目的:比较开腹全子宫切除术(AH)和腹腔镜辅助的阴式全子宫切除术(LAVH)对胰岛素抵抗及血管紧张素转换酶(ACE)的影响。方法:选择2009年10月至2011年3月择期行全子宫切除术患者80例,按患者意愿分成AH组和LVAH组,每组40例。监测两组患者麻醉前(T0时)、麻醉诱导插管后(T1时)、气腹建立或开腹30分钟(T2时)、气腹撤除或关腹10分钟(T3时)和术后1小时(T4时)、术后次日晨7时(T5时)、术后第3天晨7时(T6时)7个时点的血糖、胰岛素、C-肽、ACE水平,并计算两组患者在不同时点的胰岛素敏感指数(ISI)。结果:①T0时两组患者的血糖、胰岛素、C-肽、ISI和ACE活性比较差异均无统计学意义(P>0.05)。②AH组血糖水平在T4～T6时均明显高于LAVH组(P<0.01,P<0.05),AH组胰岛素及C-肽水平在T2时低于LAVH组(P<0.01),但T5时和T6时均持续高于LAVH组(P<0.01,P<0.05)。③AH组T4～T6时ISI明显低于LAVH组(P<0.01),两组T5时ISI水平与术中出血量呈负相关(rAH=-0.507,PAH=0.008;rLAVH=-0.424,PLAVH=0.017)。④两组ACE水平在T2、T4时明显高于T0时(P<0.01)。LAVH组ACE水平至T2时点最高,并明显高于AH组(P<0.01),术后下降迅速。结论:两种不同子宫切除术式均引起糖代谢和ACE的异常,LAVH对术后胰岛素抵抗的影响小于传统的AH,但CO2气腹对ACE活性的影响大于AH。
Objective：To compare the effects of Laparoscopically Assisted Vaginal Hysterectomy （LAVH） and Abdominal Hysterectomy （AH） on insulin resistance and angiotensin-converting enzyme. Methods： Eighty patients （ASA Ⅰ -Ⅱ ） scheduled for hysterectomy from October 2009 to March 2011 were enrolled in this study. According to their own will, the patients were divided into groups Ⅰ and Ⅱ （40 cases in each）. Group I were underwent AH, while Group II underwent LAVH. All operations were performed under general anesthesia. The serum levels of blood glucose, insulin, C-peptid, and angiotensin-converting enzyme （ACE） were measured at seven time points：before the anesthesia （T0）, after induction of anesthesia and tracheal intubation （T1） ,30 minutes after beginning the operations （T2）, 10 minutes after the end of surgery （T3）, 1 hour after the end of surgery （T4） ,7am. on the next day of operation（T5） ,7am. on the third day of opera- tion （T6）. And the insulin sensitivity index （ISI） of the patients at different time points were calculated. Re- sults：①Before Anesthesia at TO of two groups of patients with blood glucose, insulin, C peptide, ISI and ACE activity,there were no significant differences（ P 〉 0.05）. ②Blood glucose levels in AH group fromT4 to T6 were significantly higher than that of LAVH group（ P = 0. 000, P =0. 006, P =0. 020） ,AH group of insulin and C-peptide levels at T2 lower than that in LAVH group （ P 〈 0.01, P 〈 0.01 ）, but at T5 and T6 were consist- ently higher than that of LAVH group （ P 〈 0.01, P 〈 0.05）. ③Intraoperative bleeding volume in LAVH groupwere less than those of AH group （P=0. 000）. In AH Group,the levels of ISI from T4 to T6 were obviously lower than those of LAVH group（ P=0. 000） ,at T5 the ISI level and operation bleeding volume was nega- tively correlated （ r_AH = -0. 507, P_AH =0. 008 ;r_LAVH = -0. 424, P_LAVH = 0. 017）.④Two groups of ACE levels in the intraoperative and postoperative were increased, and at T2 ,T4 was significantly higher than at TO （ P 〈 0. 01 ）. The serum concentration of ACE in LAVH group at T2 to the highest, and was obviously higher than that in AH group （ P 〈 0.01 ）, but dropped quickly after the operation. Conclusions：Two types of Hysterecto- my led to abnormal glucose metabolism,of which LAVH caused less influence on postoperative insulin resist- ance than AH,but greater influence of CO2 pneumoperitoneum on angiotensin-converting enzyme than AH.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2013年第1期56-60,共5页
Journal of Practical Obstetrics and Gynecology
