全身麻醉深度对糖尿病患者术中血清CGRP、SP浓度的影响  

Effects of general anesthesia depth on intraoperative calcitonin gene-related peptide and substance P in diabetic patients

作　　者：李怀亮 马崇皓 张妙 李宇恒 郭政[2] Li Huailiang;Ma Chonghao;Zhang Miao;Li Yuheng;Guo Zheng(School of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China;Department of Anesthesiology,the Second Hospital of Shanxi Medical University,Taiyuan030001,China)

机构地区：[1]山西医科大学麻醉学院,太原030001 [2]山西医科大学第二医院麻醉科,太原030001

出　　处：《国际麻醉学与复苏杂志》2022年第8期850-855,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨不同麻醉深度对糖尿病患者血清降钙素基因相关肽(calcitonin gene-related peptide,CGRP)和P物质(substance P,SP)浓度的影响.方法选择全麻下行腹腔镜手术的患者78例,年龄42~70岁,性别不限,ASA分级Ⅰ、Ⅱ级.根据术前是否合并2型糖尿病分为非糖尿病组(NDM组,40例)和糖尿病组(DM组,38例),两组患者再分别按随机数字表法分为非糖尿病浅麻醉组(LNDM组,20例)、非糖尿病深麻醉组(DNDM组,20例)、糖尿病浅麻醉组(LDM组,19例)、糖尿病深麻醉组(DDM组,19例).LNDM组、LDM组BIS值维持在50~59,DNDM组、DDM组BIS值维持在40~49.记录4组患者术前及术中情况(如麻醉时间、手术时间、停药后睁眼时间、PACU停留时间,麻醉药物用量,术中补液量、术中失血量、尿量等),记录4组患者术中不良心血管事件发生率及血管活性药物使用率,采用ELISA法测定4组患者术前和术毕时血清CGRP、SP浓度.结果与LNDM组比较:LDM组、DDM组术前血清CGRP、SP浓度均较低(P<0.05);DNDM组、DDM组丙泊酚用量增多(P<0.05)、停药后睁眼时间延长(P<0.05);DNDM组、LDM组、DDM组术毕血清CGRP、SP浓度均降低(P<0.05),DDM组术中不良心血管事件总发生率升高(P<0.05),术中血管活性药物总使用率升高(P<0.05).与DNDM组比较:LDM组、DDM组术前、术毕血清CGRP和SP浓度均较低(P<0.05);LDM组丙泊酚用量减少(P<0.05)、停药后睁眼时间缩短(P<0.05);DDM组术中不良心血管事件总发生率升高(P<0.05),DDM组术中血管活性药物使用率升高(P<0.05).与LDM组比较:DDM组丙泊酚用量增多(P<0.05)、停药后睁眼时间延长(P<0.05),术中不良心血管事件总发生率升高(P<0.05),术中血管活性药物使用率升高(P<0.05),术毕血清CGRP、SP浓度均降低(P<0.05).Logistic回归分析示术前血清CGRP[比值比(odds ratio,OR)0.78,95%CI 0.65~0.94,P=0.010]、SP浓度(OR0.98,95%CI0.97~0.10,P=0.020)是术中不良心血管事件发生率升高的影响因素.结论深麻醉是CObjective To investigate the effect of anesthesia depth on intraoperative calcitonin gene-related peptide(CGRP)and substance P(SP)in diabetic patients.Methods A total of 78 patients,aged 42-70 years old,American Society of Anesthesiologists(ASA)grades I or II,who were scheduled for laparoscopic surgery under general anesthesia were enrolled.According to the presence of type 2 diabetic melltus,they were divided into two groups:a non-diabetic(NDM)group(n=40)and a diabetic(DM)group(n=38).According to the random number table method,they were then divided into four groups:a light anesthesia non-diabetic(LNDM)group(n=20),a deep anesthesia non-diabetic(DNDM)group(n=20),a light anesthesia diabetes(LDM)group(n=19),and a deep anesthesia diabetes(DDM)group(n=19).The BIS value was maintained in a range of 50-59 for the LNDM and LDM groups,and in a range of 40-49 for the DNDM and DDM groups.Their general information,including anesthesia time,operation time,eye-opening time after drug withdrawal,the length of post-anesthesia care unit(PACU)stay,anesthetic dosage,intraoperative fluid replacement volume,intraoperative blood loss,and urine volume were recorded.The incidence of adverse cardiovascular events and the use of vasoactive drugs during surgery were recorded.Blood samples were taken before anesthesia induction and at the end of surgery for determination of serum CGRP and SP by enzyme linked immunosorbent assay(ELISA).Results Compared with the LNDM group,the concentrations of preoperative serum CGRP and SP decreased in the LDM group and the DDM group(P<0.05);the dosage of propofol in the DNDM and DDM groups increased(P<0.05),eye-opening time was prolonged after drug withdrawal(P<0.05);the concentrations of serum CGRP and SP in the DNDM group,the LDM group,and the DDM group decreased after surgery(P<0.05),the total incidence of intraoperative adverse cardiovascular events in the DDM group increased(P<0.05),and the total use rate of intraoperative vasoactive drugs increased(P<0.05).Compared with the DNDM group,LDM group and

关 键 词：麻醉深度 糖尿病 术中不良心血管事件 辣椒素受 体降钙素基因相关肽 P物质 

分 类 号：R614[医药卫生—麻醉学]