硬膜外腔注射糖皮质激素对血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响

《硬膜外腔注射糖皮质激素对血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、授权单位代码10089学号或申请号20152076中国图书分类号R614HebeiMedicalUniversity硕士学位论文学术学位硬膜外腔注射糖皮质激素对血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响研究生：韩文彪导师：刘广召教授专业：麻醉学二级学院：河北医科大学第二医院2018年3月目录中文摘要················································································1英文摘要·······················································

2、·························3英文缩写················································································6研究论文硬膜外腔注射糖皮质激素对血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响前言················································································7材料与方法······················································

3、·················8结果···············································································10附图···············································································12附表···············································································18讨论······················

4、·························································21结论···············································································27参考文献·········································································27综述糖皮质激素在疼痛微创介入治疗中的应用····························31致谢··················

5、···································································40个人简历···············································································41中文摘要硬膜外腔注射糖皮质激素对血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响摘要目的：本研究拟观察单次硬膜外腔注射不同剂量的复方倍他米松和地塞米松棕榈酸酯对患者血糖、血脂及下丘脑-垂体-肾上腺皮质轴的影响。方法：选取腰椎间盘突出症下肢疼痛患者40例，其中女性18例，男性22

6、例，年龄在22～65岁，体重在48～75kg，病程为1～6年。所有患者行硬膜外腔置管单次注射药物治疗，根据患者应用的药物种类与剂量的不同，按照随机数字表法分为4组：A1组为3.5mg复方倍他米松组，A2组为7mg复方倍他米松组，B1组为4mg地塞米松棕榈酸酯组，B2组为8mg地塞米松棕榈酸酯组。每组10例患者。常规消毒选择病变间隙直入法或侧入法穿刺，穿刺针进入硬膜外腔，以阻力突破感以及无气泡压缩判定穿刺针进入硬膜外腔，置入硬膜外导管，并留置3cm于硬膜外腔，回抽无血、无脑脊液后注射含糖皮质激素药物、2%利多卡因1ml和0.9％氯化钠混合注射液共5ml。A1组：注射复方倍他米松

7、3.5mg，A2组：注射复方倍他米松7mg，B1组：注射地塞米松棕榈酸酯4mg，B2组：注射地塞米松棕榈酸酯8mg。记录各组患者治疗前与治疗后的疼痛程度，疼痛程度评分采取疼痛视觉模拟评分法(visualanaloguescale，VAS)，测定治疗前（T0）和治疗后第2d（T1）、4d（T2）、6d（T3）、14d（T4）及21d（T5）8:00空腹血糖、血浆总胆固醇、甘油三酯、血浆皮质醇、促肾上腺皮质激素（adrenocorticotropichormone，ACTH）浓度，10:00餐后2h血糖浓度