摘要
目的观察减重手术前后肥胖患者血浆生长分化因子15水平的变化及其与体重指数(BMI)和术后急性疼痛的关系。方法前瞻性选取2019年11月至2020年12月期间在首都医科大学附属北京友谊医院实施择期减重手术的24例肥胖患者作为研究对象。根据BMI进行分组,将BMI<32.5 kg/m^(2)作为研究组(n=12),BMI≥32.5 kg/m^(2)作为对照组(n=12)。检测并比较两组患者术前和术后24 h的血浆GDF15浓度,记录术中阿片类药物用量,采用数字评定量表(NRS)评价术后1、4、8、24 h疼痛强度。采用Spearman检验分析GDF15血浆水平、BMI和术后疼痛强度之间的关系。结果研究组患者术前和术后24 h的GDF15血浆水平分别为(107.2±33.7)、(137.2±31.5)pg/mL;对照组患者术前和术后24 h的血浆GDF15水平分别为(110.6±39.4)、(145.5±42.3)pg/mL。术前、术后24 h,两组血浆GDF15水平比较,差异无统计学意义(P>0.05);两组术后24 h的血浆GDF15水平均较术前明显升高,差异均有统计学意义(P<0.05)。两组患者术中镇痛药物舒芬太尼和瑞芬太尼用量比较,差异均无统计学意义(P>0.05)。重复测量方差分析结果显示,两组不同时间点的NRS评分比较,差异有统计学意义(P<0.05);不同时间NRS评分和分组无交互作用,差异均无统计学意义(P>0.05)。术前与术后GDF15血浆水平之间呈显著正相关(P<0.05),BMI与术后GDF15血浆水平呈显著负相关(P<0.05);术前与术后GDF15血浆水平与术后24 h疼痛强度的NRS无显著相关(P>0.05)。结论在实施腹腔镜下袖状胃手术肥胖患者发现,GDF15血浆水平虽然可作为术后早期急性应激反应的指标,但术前和术后GDF15血浆水平不能作为反映术后疼痛强度的有用参数,且BMI与术后早期疼痛强度无关。
Objective To investigate the effect of bariatric surgery on plasma growth differentiation factor 15(GDF15)in obese patients and the relationships of plasma GDF15 level,body mass index(BMI)and postoperative acute pain.Methods Twenty-four obese patients who underwent elective bariatric surgery in Beijing Friendship Hospital,Capital Medical University from November 2019 to December 2020 were prospectively selected as the study subjects.According to different BMI groups,BMI<32.5 kg/m^(2) as the study group(n=12),BMI≥32.5 kg/m 2 as the control group(n=12).The levels of plasma GDF15 were measured and compared between the two groups before and 24 h after operation.The intraoperative opioid dosage was recorded.The pain intensity at 1,4,8 and 24 h after operation were determined by numeric rating scale(NRS).The relationships among plasma GDF15 levels,BMI and postoperative NRS scores was determined by Spearman test.Results The plasma levels of GDF15 in the study group before and 24 h after operation were(107.2±33.7)pg/mL and(137.2±31.5)pg/mL,respectively.The plasma GDF15 levels in the control group before and 24 h after operation were(110.6±39.4)and(145.5±42.3)pg/mL,respectively.Before operation and 24 h after operation,there was no statistically significant difference in plasma GDF15 level between the two groups(P>0.05);the levels of plasma GDF15 at 24 h after operation in both groups were significantly higher than those before operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the dosage of sufentanil and remifentanil between the two groups(P>0.05).The results of repeated measures analysis of variance showed that there was statistically significant difference in NRS scores between the two groups at different time points(P<0.05).There was no interaction between NRS score and group at different time points,and the difference was not statistically significant(P>0.05).There was a significant positive correlation between preoperative and postoperative GDF15 plasma levels(P<0.05),and BMI was significantly negatively correlated with postoperative GDF15 plasma levels(P<0.05).There was no significant correlation between preoperative and postoperative GDF15 plasma levels and NRS of pain intensity at 24 h after surgery(P>0.05).Conclusion This study demonstrates that plasma GDF15 level can be used as an index of early postoperative acute stress response in obese patients undergoing bariatric surgery with sleeve gastrectomy.However,preoperative and postoperative plasma GDF15 levels are not the useful parameters of postoperative pain intensity.The patients'BMI is not significantly correlated with the early postoperative pain intensity.
作者
薛照静
张愿
袁玉静
薛富善
XUE Zhao-jing;ZHANG Yuan;YUAN Yu-jing(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《临床和实验医学杂志》
2024年第20期2238-2240,F0003,共4页
Journal of Clinical and Experimental Medicine
基金
2018年贝朗麻醉科学研究基金资助项目(编号:BBDF-2018-001)。
关键词
肥胖
疼痛
生长分化因子15
减重手术
Obesity
Pain
Growth differentiation factor 15
Bariatric surgery
作者简介
通信作者:薛富善,Email:xuefushan@aliyun.com。
