腹部手术时芬太尼对糖耐量试验中去甲肾上腺素的影响

Effect of Fentanyl on Norepinephrine Release during GLucose Tolerance Test in Patients Undergoing Abdominal Surgery

探讨芬太尼在静脉普鲁卡因复合麻醉（ＩＰＢＡ）中对腹部手术病人糖耐量的影响机制。２４例择期手术病人于术前行第１次糖耐量试验后接受ＩＰＢＡ，切皮前均给予１０μｇ／ｋｇ的芬太尼。术中６０分钟时将病人分成２组，Ⅰ组病人接受１０ｍｌ生理盐水，Ⅱ组病人在１０ｍｌ生理盐水中再加入５μｇ／ｋｇ芬太尼。然后行第２次糖耐量试验。血浆去甲肾上腺素（ＮＥ）浓度的测定采用高效液相电化学法（ＨＰＬＣ）。结果示，Ⅰ组第２次ＫＧ值比第１次下降明显（Ｐ＜０．０１）。Ⅱ组２次ＫＧ值无显著差异。术中糖耐量试验时Ⅰ组２０和３０分钟时胰岛素水平均低于Ⅱ组，而１０和３０分钟时的ＮＥ水平均高于Ⅱ组同时的值。本研究表明，ＩＰＢＡ中辅以１０μｇ／ｋｇ芬太尼时，术中交感神经系统活跃。适当增加芬太尼可削弱交感神经的兴奋程度，促使胰岛素释放，从而改善糖的利用和避免糖耐量下降。

The mechanism of effect of fentanyl on glucose tolerance was studied in 24 patients undergoing adbominal surgery under intravenous procaine balanced anesthesia(IPBA). The first intravenous glucose tolerance test (IVGTT) was done before anesthesia. Before skin incision the first dose of fentanyl(10 μg·kg -1 ) was given in all cases. At 60 min after skin incision 12 patients received 10 ml of normal saline(Group Ⅰ) and another 12 patients were given the second dose of fentanyl(5 μg·kg -1 ) in 10 ml of normal saline (Group Ⅱ). After that, the second IVGTT was carried out in two groups. The plasma norepinephrine(NE) concentration was measured by HPLC technique. The results show that the K G value during the second IVGTT in group Ⅰ was significantly decreased compared with that of the first IVGTT ( P <0.01), but no significant difference was seen in K G value between the two tests in group Ⅱ. The insulin level of group Ⅰ at 20 min、30 min during the second test was significantly lower thatn that of group Ⅱ(both; P <0.05). The NE level of group Ⅰ at 10 min, 30 min during the second test was significantly higher thatn that of goup Ⅱ (both; P <0.05). It is concluded that activity of the sympathetic nervous system is increased by an increase of NE during abdominal surgery under IPBA with fentanyl 10 μg·kg -1 . The increased sympathetic activity can be diminished by supplemental . Thus, insulin secretion, glucose tolerance and glucose utilization are improved during surgical stress.