极化液对70岁以上手术患者应激性高血糖的影响  

Effect of Glucose-insulin-potassium on stress-induced hyperglycemia in surgical patients above 70 years old

作　　者：周树保[1,2] 屠伟峰[1] 郄文斌[1] 戴建强[1] 

机构地区：[1]广州军区广州总医院麻醉科,广州510010 [2]南方医科大学

出　　处：《广东医学》2009年第3期380-382,共3页Guangdong Medical Journal

基　　金：广州市科技计划项目(编号:2008Z1-E421)

摘　　要：目的探讨手术期间极化液对70岁以上老年患者应激性高血糖的影响。方法择期行非心脏手术患者32例,年龄≥70岁,ASA为Ⅰ～Ⅱ级,随机分为极化液组(G组,n=16)和对照组(C组,n=16)。G组检测完血糖后输注极化液(500 g/L葡萄糖注射液50 mL+正规胰岛素10 IU+KCl 4 mmol)0.4 mL/(kg.h)至手术结束。用罗康全活力型血糖检测仪分别在麻醉前、手术开始、手术结束检测末梢血糖。结果两组手术开始和手术结束的血糖值较麻醉前均升高(P<0.05),C组三个时间点的血糖值逐渐升高,但G组手术结束的血糖值较手术开始降低,两组内手术开始和手术结束的血糖值比较差异无显著性(P>0.05);两组间血糖值比较差异有显著性(P<0.05)。结论极化液能有效地控制手术期间的应激性高血糖,可能会减少相关的并发症。Objective To investigate the effect of Glucose -insulin- potassium （GIK） on stress -induced hyperglycemia in surgical patients above 70 years old. Methods Thirty - two ASA Ⅰ - Ⅱ patients aged （ 70 years undergoing elective abdominal or lumbar spine surgery or operation on the lower limbs were randomly divided into 2 groups： GIK group（ G,n = 16） and control group（ C,n = 16）. GIK therapy （50% dextrose 50 mL, regular insulin 10 IU, and potassium chloride 4 mmol） at a dose of 0.4 mL/（ kg · h） was administered from start of anesthesia until the end of operation after measurement of blood glucose. Peripheral blood glucose levels were measured by ACCU - CHEK Active before anesthesia and at the start and at the end of operation. Results Blood glucose levels at the start and at the end of operation were significantly higher than that of before anesthesia （ P 〈 0.05 ）. The blood glucose levels gradually increased at three time points in group C, but the blood glucose level at the end of operation was significantly lower than that at the start of opera- tion. There was no significant difference in the blood glucose level between at the start and at the end of operation in both groups （P 〉 0.05 ）. There was significant difference in blood glucose level between the two groups. （P = 0.013 ）. Conclusion GIK can effectively control stress - induced hyperglycemia and may reduce associated complications during operation.

关 键 词：极化液 应激 血糖 老年 麻醉 

分 类 号：R542.22[医药卫生—心血管疾病] R654.2[医药卫生—内科学]