糖尿病患者全麻下行上腹部手术中血糖和糖代谢激素的变化  

Changes of blood glucose and glucose metabolism during surgery under general anesthesia in diabetic patients

作　　者：杨瑞[1] 秦秦[1] 张昕[1] 杨春艳[1] 王晖[1] 焦哲顺[1] 兰自侃[1] 

机构地区：[1]陕西省人民医院麻醉科,西安市710068

出　　处：《临床麻醉学杂志》2008年第4期292-294,共3页Journal of Clinical Anesthesiology

基　　金：陕西省社发攻关项目(项目编号:2003K10-G99)

摘　　要：目的观察手术及麻醉应激状态下血糖及糖代谢激素的变化。方法40例ASAⅠ或Ⅱ级,全麻下择期行上腹部手术患者,2型糖尿病患者组(G组)20例,非糖尿病患者组(N组)20例,均采用静吸复合麻醉,两组患者分别于麻醉前、手术1、2h和拔管后2min四个时点抽取非输液侧肘静脉血,测定血糖(Glu)、胰岛素(Ins)、生长激素(GH)、皮质醇(Cor)、胰高血糖素(GC)、C-肽、促肾上腺皮质激素(ACTH)。结果两组患者Glu在手术1、2h及拔管后2min均升高(P<0·01),且G组升高的幅度明显大于N组(P<0·05)。Ins在N组仅在拔管后2min升高(P<0·05),G组手术1、2h及拔管后2min均高于麻醉前(P<0·05或P<0·01)及N组(P<0·05)。GH、Cor、ACTH在两组于手术1、2h、拔管后2min均升高(P<0·05),组间差异无统计学意义。GC及C-肽于拔管后2min高于麻醉前(P<0·05),组间差异无统计学意义。Glu的变化与Cor、GH、ACTH呈正相关(P<0·05)。结论2型糖尿病患者麻醉手术应激状态下Glu升高和糖代谢激素的变化比非糖尿病患者明显。Objective TO observe the changes of blood glucose （Glu） and glucose metabolism during surgery in patients with type 2 diabetes mellitus （T2DM）. Methods Forty ASA physical status Ⅰ or Ⅱ patients, scheduled for selective abdominal surgery under general anesthesia were divided into 20 cases of T2DM （group G） and 20 cases with normal glucose tolerance （group N）. Blood samples were taken for the measurements of Glu, insulin （Ins）, growth hormone （GH）, corticosol （Cor）,glucagon （GC）,C-peptide and ACTH before induetion of anesthesia, at 1,2 h after skin incision. Results Glu significantly increased at 1,2 h after skin incision compared with that before in both groups （P〈0.01） ,which was more in group G than that in group N （P〈0.05）. GH, ACTH and Cor were significantly increased at 1,2 h after skin incision than those before in both groups （P〈0.01）, which were not statistically different between the two groups. Compared with before anesthesia,Ins in group N significantly increased after extubation （P〈0.05）, but significantly increased at 1,2 h after skin incision in group G （P〈0.01）. GC and C-peptide significantly increased after extubation （P〈0.05）, but there were no statistical differences between the two groups. The hyperglycemia was positively correlated with ACTH, Cor and GH （P〈 0.05）. Conclusion The disorder of Ins,GH,Cor,GC,C-peptide and ACTH release is more in T2DM patients than that in the cases without DM.

关 键 词：糖尿病 应激 激素 

分 类 号：R614.2[医药卫生—麻醉学]