腰硬联合麻醉对高龄糖尿病患者血流动力学及血糖的影响  

Influence of combined spinal-epidural anesthesia on hemodynamics and blood glucose in the advanced age patients with diabetes mellitus

作　　者：方华[1] 杨国荣[1] 

机构地区：[1]杭州市余杭区第三人民医院麻醉科,浙江杭州311115

出　　处：《全科医学临床与教育》2010年第5期524-527,共4页Clinical Education of General Practice

摘　　要：目的探讨腰硬联合麻醉对高龄糖尿病患者血流动力学和血糖的影响。方法将50例75岁以上需行择期手术糖尿病患者随机分成两组,每组25例。Ⅰ组为腰硬联合麻醉组,Ⅱ组为硬膜外阻滞组。观察并记录入室时(T1)、麻醉后20min(T2)、切皮时(T3)、手术开始30min(T4)及术毕(T5)两组患者血流动力学(SBP、DBP、HR、SpO2)的变化,和血糖的变化及术中使用麻黄碱、辅助药物、胰岛素的例数。结果两组患者麻醉后均有不同程度的血压下降,Ⅱ组比Ⅰ组血压波动更明显,两组T2、T3和T4的SBP和T4的DBP比较,差异均有统计学意义(t分别=4.21、5.73、4.72、4.43,P均<0.05);两组T2、T3和T4的HR比较,Ⅱ组比Ⅰ组波动更明显,差异亦有统计学意义(t分别=2.97、3.41、4.07,P均<0.05)。与T1比较,Ⅰ组各时间段血糖变化,差异无统计学意义(F=0.42,P>0.05)。Ⅱ组血糖的变化,差异有统计学意义(F=9.97,P<0.05),两组病人血糖的变化比较,Ⅱ组T3和T5的血糖水平明显高于Ⅰ组,差异均有统计学意义(t分别=4.95、4.73,P均<0.05)。Ⅱ组麻黄碱、胰岛素、辅助氟芬合剂的术中使用率明显高于Ⅰ组,差异均有统计学意义(χ2分别=7.26、5.57、8.58,P均<0.05)。结论在充分做好术前准备的情况下腰硬联合麻醉对高龄糖尿病患者能有效地抑制术中应激反应,维持血流动力学及血糖的稳定,安全有效。Objective To investigate the influence of combined spinal-epidural anesthesia on hemodynamics and blood glucose in the advanced age patients with diabetes mellitus.Methods Fifty patients aged over 75 with diabetes mellitus underwent elective surgery and were randomly divided into two groups：patients in groupⅠ were under combined spinal-epidural anesthesia;patients in groupⅡ were under epidural anesthesia.The levels of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,electrocardiograph（ECG）,blood oxygen saturation（SPO2） and blood glucose were analyzed and recorded at the time of entering the operating room（T1）,20 min after anesthesia（T2）,performing skin incision（T3）,30 min after operation（T4） and at the end of the operation（T5）;the number of patients treated with ephedrine,insulin and adjuvant medications were also recorded.Results Blood pressures in two groups were decreased at varying degrees after anesthesia and the fluctuation of blood pressure were more significant in groupⅠ than those in group Ⅱ;SBP of T2,T3 and T4 and DBP of T4 in two groups had statistical significances（t=4.21,5.73,4.72,4.43,P0.05）.The fluctuations of HR in T2,T3 and T4 of group were more significant than those in group Ⅱ（t=2.97,3.41,4.07,P0.05）.Compared with blood glucose levels of T1 in group Ⅰ,those of other time points showed no statistical significance（F= 0.42,P0.05）.While compared with blood glucose levels of T1 in group Ⅱ,those of other time points showed statistical significance（F= 9.97,P0.05）.The blood glucose levels of T3 and T5 were higher in group Ⅱ than those in group I and the differences had the statistical significance（t=4.95,4.73,P0.05）.The numbers of patients treated with ephedrine,insulin and adjuvant medications（droperidol and fentanyl） were more in group Ⅰthan those in groupⅡ and showed statistical significance（χ2=7.26,5.57,8.58,P0.05）.Conclusions Together with proper and sufficient preoperative preparati

关 键 词：高龄患者 糖尿病 腰硬联合麻醉 血流动力学 血糖 

分 类 号：R614[医药卫生—麻醉学]