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目的：观察应激时血糖代谢与神经内分泌改变的关系，探讨胰岛素抵抗的机制和意义。方法：前瞻性，教学医院SICU，外科大手术后病人30例。于术毕即刻（AS）、脱离呼吸机后（AW）和术日凌晨（NM）分别测定外周血糖和胰岛素（INS）、C肽（C-P）、皮质醇（CORT）、促肾上腺皮质素（ACTH）、生长激素（GH）、胰高糖素（GL）（以上放免法），肾上腺素（E）和去甲肾上腺素（NE）（高效液相色谱法）水平。结果采用秩和检验及多元直线相关进行统计学分析。结果：术后患者的血糖及CORT、ACTH、E和NE均显著升高，分别为2．3g／L、280．7μg／L、47．6ng／L、324.4ng／L和1511．0ng／L；脱机后逐渐下降，至凌晨显著降低，分别为1．89g／L、134．4μg／L、7．38ng／L、92．6ng／L和975．5ng／L。C－P明显升高并和INS一起逐渐递增，在AS和NM分别为3．59μg／L，对5．27ng／L和20．8mU／L对32．7mU／L。GH和GL3个时相均在正常范围。结论：外科术后早期存在应激性高血糖和胰岛素抵抗，血糖水平主要受NE调节，24h后逐渐复常；胰岛素抵抗的原因在效应细胞受体下调，是机体应激时重要的自我保护手段。
Objective: To observe the relationship between the changes of blood glucose and neuroendocrine during stress, and to explore the mechanism and significance of insulin resistance. Methods: Prospective, teaching hospital SICU, surgical patients after surgery in 30 cases. Peripheral blood glucose and insulin (INS), C peptide (CP), cortisol (CORT), adrenocorticotrophic hormone (ACTH) were measured at AS, AW, and NM. ), Growth hormone (GH), glucagon (GL) (radioimmunoassay), epinephrine (E) and norepinephrine (NE) (high performance liquid chromatography). Results using rank sum test and multiple linear correlation for statistical analysis. Results: The postoperative blood glucose and the levels of CORT, ACTH, E and NE were significantly increased, which were 2.3g / L, 280.7μg / L, 47.6ng / L, 324.4ng / L and 1511.0ng / L ; It decreased gradually after going offline and decreased significantly to the early hours, which were 1.89g / L, 134.4μg / L, 7.38ng / L, 92.6ng / L and 975.5ng / L, respectively. C-P was significantly increased and gradually increased with INS, at 3.59 μg / L for AS and NM, respectively, and 5.27 ng / L for 20.7 and 32.7 mU / L for 20.8 mU / L. GH and GL3 are in the normal range of time. CONCLUSIONS: There are stress hyperglycemia and insulin resistance in the early postoperative period. The blood glucose level is mainly regulated by NE and gradually normalized after 24h. The reason of insulin resistance is down-regulated in effector cells, which is an important means of self-protection when the body is stressed .