不同麻醉方式对糖尿病视网膜病变玻璃体切除患者围术期血糖影响  

The effect of anesthetic methods on perioperative blood glucose of patients undergoing vitrectomy with diabetic retinopathy

作　　者：奚春花[1] 马凯[2] 潘楚雄[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京市100730 [2]首都医科大学附属北京同仁医院眼科中心,眼科学与视觉科学北京市重点实验室

出　　处：《中国实用眼科杂志》2016年第10期1077-1081,共5页Chinese Journal of Practical Ophthalmology

摘　　要：【摘要】目的探讨全身麻醉及局部麻醉对糖尿病视网膜病变行玻璃体切除术患者围术期血糖的影响。方法临床病对照研究。对2015年3~9月在北京同仁医院眼科就诊的2型糖尿病增殖性视网膜病变行玻璃体切除术患者52例，依据术者选择分为局部麻醉组27例及全身麻醉组25例。局部麻醉采用球后阻滞，全身麻醉采用喉罩通气，静脉或者静脉复合吸入维持麻醉。采集所有患者术前、手术当天及术后一至三天空腹及三餐后血糖值，记录围术期血糖及心血管不良事件。结果两组患者围术期血糖变化趋势基本一致，空腹血糖在术后第一天达到高峰，餐后血糖在手术当晚达到高峰，术后第三天恢复至术前状态。组间比较局麻组手术当天早午餐后及术后第二天空腹血糖与全麻组差异有统计学意义（P〈0．05）。两组围术期低血糖发生率差异无统计学意义（P=0．51），需额外静脉输注胰岛素发生率差异无统计学意义（P=0．157）。局麻组有一例出现术中急性心肌缺血不能完成手术，一例出现术后体位性低血压晕厥，全麻组均顺利完成手术。结论与局部麻醉相比，全身麻醉并未增高糖尿病增殖性视网膜病变患者行玻璃体切除术围术期血糖，也未增加其他血糖及心血管不良事件，可为复杂玻璃体切除术提供更满意的麻醉效果。Objective To evaluate the effect of anesthetic methods on perioperative blood glu- cose of patients undergoing vitrectomy with proliferative diabetic retinopathy （PDR）. Methods Fif- ty-two patients with type 2 diabetic mellitus and PDR scheduled for vitrectomy, were arranged to ac- cept regional anesthesia （RA） or general anesthesia （GA）. The fasting blood glucose （FBG） and post- prandial blood glucose （PBG） were monitored perioperatively. Results All patients had the same change trend of blood glucose. The peak of FBG happened on the first day after the surgery and the peak of PBG on the evening right after surgery. Both the PFG on the surgical day and the FBG on the first day after surgery of patients in Group RA had statistical difference with that of GA （P 〈0.05）. There was no statistical difference of the incidence of hypoglycemia between two groups （P =0.51）. Conclusions Compared with regional anesthesia, general anesthesia has no signifi- cant impairment on the blood glucose and do not increase other cardiovascular events. GA provides a better care for patients with PDR undergoing complicated vitrectomy.

关 键 词：糖尿病 增殖性视网膜病变 玻璃体切除术 血糖 麻醉 

分 类 号：R587.2[医药卫生—内分泌]