摘要
目的:探讨不同麻醉方法对行腹腔镜子宫全切2型糖尿病(T2DM)患者血流动力学、血糖水平及补体C3、C4的影响。方法:前瞻性选择2016年1月至2019年1月期间我院收治的120例拟行腹腔镜子宫全切术的T2DM患者,采用随机数字表法将患者分为两组,A组(60例)采用靶控输注丙泊酚、瑞芬太尼全麻,B组(60例)采用靶控输注丙泊酚、瑞芬太尼复合吸入七氟醚全麻。观察两组围手术期血流动力学、血糖、胰岛素、胰高血糖素、C肽及补体C3、C4水平变化和差异,对比两组麻醉效果。结果:B组苏醒时间、拔管时间短于A组(P<0.05),苏醒后视觉模拟评分法(VAS)评分低于A组(P<0.05)。B组建立气腹前(T1)、建立气腹后1.5 h(T2)、手术结束时(T3)、苏醒时(T4)观测点平均动脉压(MAP)高于A组(P<0.05)。建立气腹前(M1)、建立气腹后1.5 h(M2)、术后第1 d(M3)、术后第3 d(M4)观测点胰岛素、C肽水平低于A组(P<0.05)。M1-M4观测点血糖高于A组(P<0.05),M2-M4观测点胰高血糖素水平高于A组(P<0.05)。M1-M4观测点补体C3、C4水平高于A组(P<0.05)。结论:靶控输注丙泊酚、瑞芬太尼复合七氟醚全麻麻醉效果更好,且有助于维持腹腔镜子宫全切T2DM患者血流动力学稳定,改善补体C3、C4水平,而靶控输注丙泊酚、瑞芬太尼全麻可维持血糖水平稳定,临床应根据患者情况选择合适的麻醉方案。
Objective:To investigate the effects of different anesthesia method on hemodynamics,blood glucose level and complementary C3 and C4 in patients with type 2 diabetes mellitus(T2 DM)undergoing laparoscopic hysterectomy.Methods:A prospective study of 120 T2 DM patients undergoing laparoscopic hysterectomy in our hospital from January 2016 to January 2019,they were divided into two groups by the method of random number table.Group A(60 cases)received general anesthesia with target controlled infusion of propofol remifentanil,group B(60 cases)received general anesthesia with target controlled infusion of propofol remifentanil combined with inhalation of sevoflurane.The changes and differences of hemodynamics,blood glucose,insulin,glucagon,C-peptide,complement C3,C4 levels were observed between the two groups,the anesthesia effect were compared between the two group.Results:The recovery time and extubation time of group B were shorter than that of group A(P<0.05),and the visual analogue scale(VAS)score after waking up was lower than that of group A(P<0.05).The mean arterial pressure(MAP)level at observation points of before pneumoperitoneum(T1),1.5 hours after pneumoperitoneum(T2),the end of operation(T3)and awakening(T4)of group B were higher than that of group A(P<0.05).Insulin,C peptide levels at observation point of before pneumoperitoneum(M1),1.5 hours after pneumoperitoneum(M2),1 day after operation(M3),3 days after operation(M4)were lower than that of group A(P<0.05),blood sugar levels at M1-M4 observation points were higher than those of group A(P<0.05),and glucagon levels at M2-M4 observation points were higher than those of group A(P<0.05).Complement C3 and C4 at M1-M4 observation points were higher than those of group A(P<0.05).Conclusion:The target controlled infusion of propofol remifentanil combined with sevoflurane has better anesthetic effect,it is helpful to maintain hemodynamic stability of patients in laparoscopic total hysterectomy with T2 DM,improve C3 and C4 levels of complement while the target controlled infusion of propofol remifentanil can maintain blood glucose stability,so the appropriate anesthesia scheme should be selected according to the patient’s condition.
作者
康晓芳
李红霞
马继红
梁丽娜
李艳丽
张在旺
KANG Xiao-fang;LI Hong-xia;MA Ji-hong;LIANG Li-na;LI Yan-li;ZHANG Zai-wang(Department of Anesthesiology,980 Hospital of Joint Service Support Force of Chinese PLA/Bethune International Peace Hospital of PLA,Shijiazhuang,Hebei,050000,China)
出处
《现代生物医学进展》
CAS
2021年第15期2882-2887,共6页
Progress in Modern Biomedicine
基金
河北省科学技术研究与发展计划项目(12277735)。
关键词
2型糖尿病
腹腔镜子宫全切术
丙泊酚
瑞芬太尼
七氟醚
靶控输注
血流动力学
血糖
补体
Type 2 diabetes mellitus
Laparoscopic total hysterectomy
Propofol
Remifentanil
Sevoflurane
Target controlled infusion
Hemodynamics
Blood sugar
Complement
作者简介
康晓芳(1974-),女,硕士,主治医师,研究方向:麻醉与器官保护,E-mail:kangxiaofangkxf@163.com;通讯作者:张在旺(1964-),男,硕士,主任医师,研究方向:临床麻醉与困难气道的处理,E-mail:13803379419@139.com。
