全麻联合硬膜外阻滞对Ⅱ型糖尿病患者开胸手术应激反应的影响  

Effects of combined general-epidural anesthesia on the stress of type 2 diabetes patients during thoracotomy

作　　者：张昕[1] 王晖[1] 白宁[1] 杨瑞[1] 王臻[1] 兰自侃[1] 

机构地区：[1]陕西省人民医院麻醉科,陕西西安710068

出　　处：《第四军医大学学报》2007年第14期1311-1313,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探讨不同麻醉方式对Ⅱ型糖尿病患者行开胸手术时应激反应的影响.方法:选择择期行开胸手术患者36例,其中非糖尿病患者12例(N组),采用全麻联合硬膜外阻滞,Ⅱ型糖尿病患者24例,随机分为2组(G1和G2),每组12例.G1组采用全麻联合硬膜外阻滞,G2采用单纯全麻.分别于术前(T1)、插管时(T2)、开胸探查时(T3)、关胸(T4)及拔管时(T5)5个时间点采集静脉血,检测血糖、胰岛素、皮质醇及促肾上腺皮质激素,同时记录血压及心率.结果:G2组患者T2,T3及T5时MAP及HR高于T1时(P<0.05).N组及G1组T3时MAP,HR较T1有所下降,但无统计学差异(P>0.05).G2组血糖高于N组及G1组(P<0.05).G2组T4及T5时胰岛素水平较T1时升高(P<0.05),且高于N组及G1(P<0.05).G2血皮质醇在在T2,T3,T4及T5时高于N组及G1组(P<0.05).G2组促肾上腺激素高于N组及G1组(P<0.05).结论:全麻联合胸段硬膜外阻滞用于Ⅱ型糖尿病患者行开胸手术,可有效减轻应激反应,将血糖调控于接近非糖尿病患者的水平.AIM： To study the effects of different anesthetic methods on the stress of the type 2 diabetes patients during thoracotomy. METHODS： Thirty-six patients undergoing thoracotomy were enrolled into the study. Of them, 12 patients were non-diabetics （group N）, and received combined general-epidural anesthesia ;24 type 2 diabetics were randomly divided into 2 groups （ n = 12, each） ： group G1 received combined general-epidural anesthesia, and group G2 received general anesthesia only. Blood samples were collected to measure the concentrations of blood glucose, insulin, cortisol, adrenocortito tropic hormone （ ACTH ） before operation （T1 ）, and at the time of endotracheal intubation （T2 ）, exploratory thoracotomy （T3 ）, closing thoracic incision （ T4 ）, extubation （ T5 ） , and the mean arterial pressure （MAP） and heant rate （HR） were recorded at the same time. RESULTS： In group G2, the MAP and HR were significantly higher at T2, T3 and T5 than at T1 （ P 〈 0.05 ）. In group N and G1 , the MAP and HR were little lower at T3 than at T1 , but the difference was not significant （ P 〉 0.05 ）. The concentrations of blood glucose in group G2 were significantly higher than those in group N and G1 （ P 〈 0.05 ）. The concentrations of insulin were significanly higher at T4 and T5 than at T1 in group G2, furthermore, they were much higher than those in group N and G1 （ P 〈 0.05 ）. The concentrations of cortisol at T2, T3, T4 and Ts in group G2 were higher than those in group N and G1 （ P 〈 0.05 ）. The concentrations of ACTH in group G1 were significantly higher than those in group N and G1 （P 〈0.05）. CONCLUSION： For type 2 diabetics receiving the thoracotomy, the combined generalepidural anesthesia can reduce the stress, thus adjusting the concentration of blood glucose to the level of patients without type 2 diabetes.

关 键 词：糖尿病 2型 应激 麻醉 胸廓切开术 

分 类 号：R614.2[医药卫生—麻醉学]