普鲁卡因静脉复合麻醉下上腹部手术病人内源性胰岛素对红细胞钙镁磷代谢影响的研究

Changes of Human Serum Insulin and Red Blood Cell Calcium, Magnesium and Inorganic Phosphate in Upper Abdominal Surgical Patients under Intravenous Procaine Balanced Anesthesia

对１５例普鲁卡因静脉复合麻醉下上腹部手术患者，动态观察了围麻醉手术期血清胰岛素和红细胞（ＲＢＣ）钙、镁、磷代谢的变化。结果显示，血清胰岛素自麻醉开始至术后１０ｍｉｎ无明显变化，但至术后２４ｈ较麻醉前出现非常显著的上升（１７．０１±５．４８升至２５．９６±１２．７４ｍｕ／Ｌ，Ｐ＜０．００１）。ＲＢＣ－Ｃａ２＋呈先升高而下降变化，但Ｔ０、Ｔ１、Ｔ２和Ｔ３四个时点间均无统计学差别。ＲＢＣ－Ｍｇ２＋在麻醉和手术创伤状态下逐渐升高，手术结束后１０ｍｉｎ时已由麻醉前６．６４±０．７３升至６．８８±０．８７μｍｏｌ／ｇＨｂ（Ｐ＜０．０５），术后２４ｈ进一步升至７．０２±０．７６μｍｏｌ／ｇＨｂ（Ｐ＜０．０１），在麻醉和手术创伤状态下明显上升，至术后１０ｍｉｎ达峰值，由麻醉前１．８１±０．５１升至２．５４±０．８０μｍｏｌ／ｇＨｂ，术后２４ｈ又降至１．４６±０．３８μｍｏｌ／ｇＨｂ，明显低于麻醉前水平（Ｐ＜０．０１）。ＲＢＣ内钙磷乘积变化类同ＲＢＣ－Ｐｉ的变化，更有意义的是普鲁卡因静脉复合麻醉下上腹部手术创伤后内源性胰岛素的变化与ＲＢＣ内钙、镁、磷及钙磷乘积有着良好的相关性（ｒ分别为－０．９４６、０．７６９、－０．９７２和?

OBJECTIVE To investigate the changes of serum insulin and red blood cell calcium(RBC Ca 2+ ),magnesium(RBC Mg 2+ )and inorganic phosphates(RBC Pi),perioperatively. METHODS Fifteen patients underwent elective upper abdominal surgery with intravenous procaine balanced anesthesia:5 males and 10 females, aged 45 90±10 20 years and weighing 60 60±11 93kg,14 for cholecystectomy and 1 for gastrectomy. Venous blood samples were collected in heparin (20u/mi) at 30 min before induction of anesthesia,60 90 min after incision, 10min and 24 hours after completion of surgery. Serum was used to determine insulin. The washed red blood cells were placed in a 50 60% red cell suspension for the assay of calcium, magnesium and inorganic phosphates. RESULTS Serum insulin remained stable from the beginning of anesthesia to ten minutes following operation, elevated significantly to 25 96±12 74mU/L(P<0 001)at 24 hours following surgery as compared with 17 01±5 48mU/L prior to anesthesia. RBC Ca 2+ showed reduction following elevation but no statistically significant differences perioperatively. The trend of gradually increased RBC Mg 2+ in general anesthesia and abdominal surgical trauma. Ten minutes and 24 hours after the end of operation, RBC Mg 2+ concentrations were increased from 6 64±0 73 to 6 88±0 87 and 7 02±0 76μmol/gHb(P<0 05 and 0 01,respectively).RBC Pi remarkably rose from 1 81±0 51 to 2 11±1 99μmol/gHb (P<0 01)and reached to the peak(2 41±0 25μmol/gHb,P<0 001),and then progressively declined to 1 45±0 17μmol/gHb(P<0 01)at the time points of T 1,T 2,and T3,respectively. The changes of the product of intraerythrocytic Ca 2+ and Pi were similar to those of RBC Pi.It was interestingly found that significantly positive correlations existed between the alterations of endogenous insulin and those of intraerythrocytic calcum, magnesium, inorganic phosphates and the product of Ca 2+ ×Pi following general anesthesia and upper abdominal surgical trauma. CONCLUTIONS The abnormal secretions of endogenous insulin and the severely disturbed metabolisms in intraerythrocytic calcium, magnesium and inorganic phosphate occur in the upper abdominal surgical patients under intravenoous procaine balanced anesthesia. The alterations of intraerythrocytic electrolytes are associated with the abnormal secretions of endogenous insulin.