应用山梨醇作为术中的供能物质  

Sorbitol as energy supply during operation

作　　者：薛智东[1] 尹大光[1] 朱姜华 程燕[1] 

机构地区：[1]北京医科大学第一医院麻醉科

出　　处：《中华麻醉学杂志》1997年第4期198-201,共4页Chinese Journal of Anesthesiology

摘　　要：目的：评价应用山梨醇作为术中的供能物质。方法：４８例（２１例为ＮＩＤＤＭ），术中用５％葡萄糖或５％山梨醇作为供能物质。一组（１８例）观察对血糖和血胰岛素的影响。另一组（３０例）观察脑组织对山梨醇的利用率与山梨醇对血乳酸和血酸碱度的影响。颈内静脉逆行置管约１５ｃｍ，收集颅内回血。血清山梨醇浓度用高压液相法测定。结果：输用葡萄糖加胰岛素（５ｇ∶１Ｕ）ＮＤＭ和ＮＩＤＤＭ患者血糖分别由８９．３６±１０．２７升至４６４．６５±２１７．９６及１７２．５±１０．２升至７１０．０±１２０．５（ｍｇ％）（Ｐ＜０．０５），同时血胰岛素皆升高超出正常范围达５５μＵ·ｍｌ－１。输用山梨醇的ＮＩＤＤＭ患者中，血糖由１７３．０±１１．５升至２８４．０±４３．５（ｍｇ％）（Ｐ＜０．０５），血胰岛素为１６．２±７．４Ｕ·ｍｌ－１。输用山梨醇，脑组织的ＲＱ为０．９１～０．９９，ＣＭＲｇｌｕ为４ｍｇ·１００ｇ－１·ｍｉｎ－１。脑组织对山梨醇的利用率为６２％（ＮＤＭ）及８５．２％（ＮＩＤＤＭ）。脑组织利用量占输入总量的１９．２％，经尿排出量占１８．５％。停输后２小时血中已无山梨醇。血乳酸含量由１．５３±０．２７增至３．５７±１．１０ｍｍｏｌ·Ｌ?Objective:To evaluate the chacteristics of sorbitol as perioperative energy supply Method:During operations 5% glucose (5g with insulin 1U) or 5% sorbitol intravenously was infused In first group (n=18),11 cases were NIDDM(Non Independent Diabetes Mellitus),7 cases were NDM(Non Diabetes Mellitus) Blood sugar(BS)and blood insulin levels (BI) were measured pre and post infusion In second group (n=30),10 cases were NIDDM,20 cases were NDM The available rate of sorbitol for brain tissue (BrT),serum lactate (SL) and blood pH value were observed Internal jugular venous blood samples were taken by canulating 15cm inversely as intracranial blood samples Serum sorbitol level was measured with high pressure liquid chromatography BP and HR were kept stable during opeations Result:In first group,infused with 5% glucose in both NDM and NIDDM,BS increased markedly (P<0 05),at the same time BI increased by 55 μU·ml -1 more than normal range But in the infusion with sorbitol in NIDDM,BS increased slightly,BI was 16 2±7 4μU·ml -1 ,respiratory quotient of BrT was 0 91 0 99,cerebral metabolic rate of glucose was 4mg·100g -1 ·min -1 ,percentage of sorbitol consumpted by BrT in NDM was 62%,in NIDDM was 85 2% Total available rate of BrT was 19 2% of the infused sorbitol,18 5% was eliminated from urine and no sorbitol was be found in urine after 2 hours of stopping infusion After the infusion of sorbitol,SL increased from 1 53±0 27 to 3 57±1 10 mmol·L -1 in NDM,from 1 12±0 36 to 1 86±0 69 in NIDDM,there was no difference in SL level between blood flow into and out of brain Blood pH values pre and post infusion of sorbitol also had no difference.Conclusion:Sorbitol can be used as energy supply during operations at dosage of 0 25g·

关 键 词：山梨醇 产能源 血糖 脑 代谢 全身麻醉 

分 类 号：R614.205[医药卫生—麻醉学]