全麻期间的血糖变化

Variation of Blood Glucose Level during General Anesthesia.

目的：观察全麻手术期间的血糖变化。方法：对51例手术病人，在咪唑安定、芬太尼、丙泊酚、琥珀胆碱静脉诱导气管内插管、吸入异氟醚和笑气及静注维库溴铵复合麻醉下手术，分别在病室内、麻醉前、术毕和拔管后抽取静脉血测定血糖。结果：术前药使57．89％病人的血糖值有所下降，从6．21±1．8retool／L降至5．07±0．9mmol／L。病人进入手术室后，13例病人（34．21％）血糖升高，从5．20±1．06mmol／L升到6．39±1．61mmol／L．手术期间80％病人的血糖升高，从5．30±1．01mmol／L升到6．63±1．52mmol／L，其中高於正常值者为48％。拔管后的血糖变化呈两极分化趋势，血糖高於正常值者为34％，高於手术中血糖值者为26％（6．57±1．65mmol／LVS6．28±1.74mmol／L，高於麻醉前血糖值者为68％，6．16±1．21mmol／Lvs5．16±0．92mmol／L，有66％病人血糖低於术中水平，6．43±1．68mmol／LVS5．21±1.80mmol／L，其中12％病人的血糖低於正常值，且有2例的血糖降至危险的水平（1．1mmol／L）。结论：由于病人对疾病和手术的焦虑、疾病的影响、手术刺激、术前镇静药和麻醉药的影响，全麻手术期间的血糖可出现明显的变化．

Objective To observe the changes of blood glucose during operation under general anesthesia. Methods A total of 51 cases were studied. General anesthesia was induced by midazolam, fentanyl, propofol and succinylcholine intravenously and was followed by endotracheal intubation, and was maintained by isoflurane, nitrous oxide and vecuronium. The patient＇s venous blood were taken at the time of admission, before anesthesia, completion of operation and after extubation separately. Blood samples were tested for blood glucose level by SureStep Plus blood glucose device. Results After premedication, the blood glucose levels of 22 cases（57.89%） dropped down from 6.21±1.8mmol/L to 5. 07±0. 9 mmol /L, and in 13 cases（34.21%） increased from 5. 20±1.06 to 6.39±1.61mmol/L. At the conclusion of operation, blood glucose levels of 40 cases （80%） went up from 5.30±1.01 to 6. 63±1.52mmol/L. After extubation the trend of the blood glucose levels of patients diverged towards two extremities. In 34 cases（68%） the blood glucose levels were higher than that before anesthesia （6. 16±1.21 vs 5. 16±0. 92mmol/L）, and in 13 cases（26%） were even higher than that during operation （6. 57±1.65 vs 6.28±1.74mmol/L）. Unanticipatedly, the blood glucose levels were lower than the normal range in 6 cases of which there were 2 cases at the dangerous level （1. lmmol/L）. Conclusion The variation of patient＇s blood glucose levels during operation under general anes- thesia is very complicated. There are many factors influencing the blood glucose levels, such as anxiety, diseaseitself, magnitude of surgical stimulation, premedication, depth of anesthesia and various properties of anesthetic agents.