Objective To investigate the effect of tramadol on perioperative insulin resistance in patients undergoing surgical operations with different trauma.Methods One hundred and twenty patients who had general and gynecology belly all numb surgical operation were divided into tramadol group and control group,each with 60 cases.Five minutes before skin incision,the tramadol group was given tramadol 1.5 mg/kg intravenously.followed immediately by a continuous infusion of 0.5 mg/kg per hour until the end of surgery,and the control group was given normal saline instead of tramadol.Blood samples were taken from vein for determination of plasma blood sugar,insulin concentrations before induction of anesthesia(T0),at the end of the operation(T1)and seven o'clock on the next morning(T2).The value of ISI Was calculated.Grading upon the trauma degree of surgical operation was divided into three groups(Ⅰ,Ⅱ,Ⅲsubgroup).Results The concentrations of blood sugar and insulin at Tohad no significant difference in Ⅰ,Ⅱ,Ⅲsubgroups in the tramadol group(P＞0.05).The concentrations of blood sugar and insulin at T1,T2 were increased significantly compared to T0 in each subgroup[To:(4.74 ±0.43)mmol/L,(15.25±1.22)U/L;T1:(5.35±0.47)mmol/L,(17.74±1.45)U/L;T2:(6.55±0.53)mmol/L,(18.59±1.56)U/L](P＜0.05),ISI was decreased(P＜0.05).The concentrations of blood sugar and insulin at T1,T2 were significantly lower in the tramadol group than those in the control group.The value of ISI was significantly higher in the tramadol group than that in the control group(P＜0.05).Conclusions The insulin resistance presents relation with the surgical operation degree.The severe the wound is,the bigger insulin resistance is.Tramadol can alleviate perioperative insulin resistance in patients undergoing surgical operations.

Objective To explore the early diagnosis of lower extremity deep venous thrombosis (LDVT)and evaluate the therapeutic effect of anticoagulant therapy in hospitalized patients with acute ischemic stroke. Methods　According to Wells model for suspecting lower extremity deep venous thrombosis,patients with suspected LDVT were confirmed by compression ultrasonography. If the patients diagnosed with LDVT had no contraindications to anticoagulant therapy,they were treated with low molecular weight heparin(LMWH)subcutaneous injection and oral warfarin at the same time.The dosage of oral warfarin was determined by Roberts'age adjusted warfarin loading protocol.LMWH was stopped when the patients'international normalized ratio(INR)was 2.0～3.0 for two consecutive days. Results From January 2003 to August 2007,2067 cases with acute ischemic stroke were admitted to the department of neurology in Huizhou Municipal Central Hospital including 18 cases with LDVT and the incidence was 0.9%.The patients with LDVT all had paralytic extremities including 13 left legs and 5 right legs with deep vein thrombosis.All the 18 cases were treated by anticoagulant including 17 cases with oral warfarin treatment for 3 months.Symptoms in all LDVT patients were eliminated.12 cases had been observed for one year and 5 cases for three months after they stopped taking warfatin.There were no patients with pulmonary thromboembolism and LDVT recurrence. Conclusions　By using Wells model for suspecting LDVT,patients with acute ischemic stroke-complicated LDVT can be timely diagnosed.The goal of prompt and enough anticoagulant can be achieved according to Roberts'age adjusted warfarin loading protocol.Because of racial difference,population difference and other unknown factors,the incidence of acute ischemic stroke patients with complicated LDVT is much lower in Huizhou.It suggests that it should be unnecessary to use LMWH in patients with acute ischemic stroke to prevent LDVT in Huizhou.