超声引导下中心静脉导管技术治疗糖尿病合并胃癌的疗效分析

The therapeutic efficacy of ultrasound-guided central venous catheterization in diabetic patients with gastric cancer

摘要:

目的 探究超声引导下中心静脉导管技术对糖尿病合并胃癌患者的治疗效果及对脂肪因子、胰岛素样生长因子1（IGF-1）表达的影响。方法 选取2018年1月—2019年6月在大连市中心医院接受治疗的糖尿病合并胃癌患者150例，将所有患者随机分为直接盲穿组和超声引导组，每组75例。采用酶联免疫吸附试验检测抵抗素、瘦素、脂联素水平。采用流式细胞仪检测外周血胰岛素样生长因子受体1（IGFR-1）、人第10号染色体缺失的磷酸酶及张力蛋白同源的基因（PTEN）、IGF-1水平。统计穿刺成功和术中血管损伤、导管漂移患者。结果 超声引导组患者治疗前后抵抗素、瘦素、脂联素、癌胚抗原、糖类抗原19-9的降低幅度大于直接盲穿组（P <0.05）。超声引导组IGFR-1、IGF-1蛋白相对表达量低于直接盲穿组（P <0.05），PTEN蛋白相对表达量高于直接盲穿组（P <0.05）。超声引导组患者一次穿刺成功率、总成功率高于直接盲穿组（P <0.05），血管损伤发生率、导管漂移发生率低于直接盲穿组（P <0.05）。超声引导组总有效率高于直接盲穿组（P <0.05），不良反应发生率低于直接盲穿组（P <0.05）。结论 超声引导下中心静脉导管技术治疗糖尿病合并胃癌可调控患者脂肪因子、IGF-1水平，降低手术过程中血管损伤和导管漂移的发生率。

关键词:糖尿病;胃癌;超声引导;中心静脉导管技术;脂肪因子;胰岛素样生长因子受体1

Abstract:

Objective To explore the therapeutic efficacy of ultrasound-guided central venous catheterization in patients with diabetes mellitus and gastric cancer and its influence on the expressions of adipokines and insulin-like growth factors-1 (IGF-1).Methods A total of 150 patients with diabetes and gastric cancer who were treated in our hospital from January 2018 to June 2019 were selected, and all patients were randomly divided into a direct vein puncture group and an ultrasound-guided group, each with 75 cases. Enzyme-linked immunosorbent assay was used to detect the levels of resistin, leptin and adiponectin. Flow cytometry was used to detect the levels of insulin-like growth factor receptor 1 (IGFR-1), phosphatase and tensin homolog deleted on chromosome 10 (PTEN), and IGF-1 in the peripheral blood. The success rate of puncture, incidence of vascular injury and that of catheter drift were analyzed.Results The differences of resistin, leptin, adiponectin, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 before and after the treatment in the ultrasound-guided group were higher than those in the direct vein puncture group (P < 0.05). The expression levels of IGFR-1 and IGF-1 protein in the ultrasound-guided group were lower than those in the direct vein puncture group, while the expression level of the PTEN protein was higher in the ultrasound-guided group relative to that in the direct vein puncture group (P < 0.05). The first puncture success rate and overall success rate were higher (P < 0.05), while the incidences of catheter drift and vascular injury were lower in the ultrasound-guided group than those in the direct vein puncture group (P < 0.05). The total effective rate of the ultrasound-guided group was higher than that of the direct vein puncture group (P < 0.05). The incidence of adverse reactions in the ultrasound-guided group was lower than that of the direct vein puncture group (P < 0.05).Conclusions The ultrasound-guided central venous catheterization can regulate the levels of adipokines and IGF-1 in patients with diabetes mellitus and gastric cancer, and reduce the incidences of vascular injury and catheter drift during the operation.

Key words:diabetes mellitus;gastric cancer;ultrasound guidance;central venous catheterization;adipokines;insulin-like growth factor receptor 1