摘要
目的和方法：为观察上腹部手术病人围术期胰岛素敏感性的改变，将３０例择期手术病人分成硬膜外阻滞组（ＥＢ，ｎ＝１５）和静脉普鲁卡因复合麻醉组（ＩＰＢＡ，ｎ＝１５）。结果：两组血糖均逐渐升高，至术后第１天达到高峰。血浆胰岛素水平的改变与血糖变化类同。术后第１天，胰岛素／胰高血糖素（Ｉ／Ｇ）达峰值。两组胰岛素敏感性指数渐降，术后第１天达最低点。两组胰岛素敏感性指数的改变与Ｉ／Ｇ比值均呈明显的负相关。去甲肾上腺素、皮质醇、β－内啡肽和醛固酮等应激激素的变化并不与胰岛素敏感性指数密切相关，上述改变在两组之间无显著性差异。结论：在ＥＢ或ＩＰＢＡ下行上腹部手术，胰岛素敏感性指数均明显降低。这是手术创伤致血糖增高的因素之一。
Objective and Methods:The perioperative changes of insulin sensitivity were studied in thirty patients undergoing elective upper abdominal surgery under either epidural block (EB, n=15 ) or intravenous procaine balanced anesthesia (IPBA, n= 15). Results: Blood glucose levels gradually increased during operation and reached to a peak level on the first postoperative day in both groups. Blood insulin levels had a similar increase as glucose. Insulin/glucagon (I/G) ratio reached to a peak level on the first postoperative day. Insulin sensitivity index of both groups, however, was gradually decreased during operation, which reached to the lowest point on the first postoperative day. The change of insulin sensitivity index was significantly negatively correlated with I/G ratio in both groups. The changes of stress hormones, such as noradrenaline, cortisol, β endorphin and aldosterone, were not significantly correlated with the insulin sensitivity index. The changes mentioned above were not signifiantly different between two groups. Conclusion:Insulin sensitivity decreases during upper abdominal surgery under either EB or IPBA, which may be one of the factors responsible for surgial stress hyperglycemia.
出处
《临床麻醉学杂志》
CAS
CSCD
1998年第5期277-279,共3页
Journal of Clinical Anesthesiology
基金
国家自然科学基金
