三种麻醉对胆囊手术病人血糖浓度的影响

The effects of three anesthetic methods on blood glucose in patients undergoing gall bladder surgery.

目的 比较胆囊手术病人围麻醉期三种麻醉方法对血糖浓度的影响。方法 择期胆囊手术病人60 例,分别施予硬膜外腔阻滞(EB组)、全麻(GA组)、硬膜外腔阻滞+全麻(EG组)。术中监测心率(HR)、平均动脉压(MAP)、血糖浓度(Glu)。监测时间点为病人进入手术室10 min(麻醉前S1 );硬膜外腔阻滞后20 min或气管插管后5 min(S2 );切皮后5 min(S3);分离胆囊颈时(S4);气管拔管后5 min或硬膜外腔阻滞手术结束后10 min(S5)。结果 EB组、GA组于S4 点血糖浓度均显著升高(P<0.05),而EG组血糖浓度水平无显著升高(P>0.05);GA组气管拔管时血糖浓度也升高显著(P<0.05),另外两组变化不显著。结论 硬膜外腔阻滞+全麻能稳定胆囊手术围麻醉期机体血糖的代谢,抑制机体的应激反应。

Objective The study was undertaken to compare the effects of three anesthetic methods on blood glucose in patients undergoing gall bladder surgery during anesthesia.Methods The patients scheduled for eleetive gall bladder surgery are given Epidural block (EB group ) , General anesthesia (GA group ) , and Epidural block plus General anesthesia (EG group ) . Heart Rate (HR) Mean Arterial Pressure (MAP) and Blood Glucose(Glu) are measured. The monitoring point was 10 minutes after the patients go into operation room (S 1 ) , 20 minutes after Epidural block or 5 minutes after Endotracheal intubation (S 2 ) ,5 minutes after skin incision(S 3 ) , dissecting gall bladder neck (S 4 ) , and 5 minutes after Endotracheal extubation or l0 minutes after operation with Epidural block (S 5 ).Results Blood Glucose concentration increases significantly on S 4 point in EB group and GA group, while it has only a slight increase in EG group. When extubation, the Blood Glucose will increase significanlly, too. The other two groups have no clear changes.Conclusion EG could stabilize Blood Glucose metabolism and inhibit the stress response during the gall bladder surgery.