靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的临床研究

The changes of plasma glucose and hemodynamics during anesthesia with target controlled infusion system for etomidate or propofol emulsion on diabetic patients

目的观察靶控输注依托咪酯与普鲁泊福麻醉对糖尿病患者围手术期血糖及血流动力学变化的影响。方法择期手术的糖尿病患者（ASA分级Ⅰ～Ⅱ级）60例随机分为两组，每组各30例。E组：使用靶控输注依托咪酯进行麻醉；P组：使用靶控输注普鲁泊福进行麻醉。分别于麻醉诱导前5min（T0）、插管时（T1）、插管后5min（T2）、手术结束（T3）、术后24h（T4）、术后48h（B）采静脉血测定血糖，并记录各时间点收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO：）。结果P组T1及T2的SBP和DBP分别为（110．63±16．92）、（108．80±20．97）mmHg（1mmHg=0．133kPa）和（66．37±8．00）、（68．60±11．19）mmHg，心率分别为（73．77±8．13）、（74．67±8．33）次／min，均较T0有所下降[SBP、DBP和HR分别为（135．01±13．45）、（79．37±8．58）mmHg和（79．73±9．06）次／min]，P〈0．05；E组T1及T2的SBP和DBP与T0比较差异无统计学意义（P〉0．05），E组T2的心率为（89．20±9．06）次／min，较T0[（80．97±8．91）次／min]有所增快（P〈0．05）。两组血糖在T1～T5均有所增高，但与T0比较差异无统计学意义（P〉0．05）。结论与靶控输注普鲁泊福麻醉相比，靶控输注依托咪酯麻醉对糖尿病患者围手术期具有更好的血流动力学稳定性；二者对患者围手术期血糖变化没有明显影响；靶控输注普鲁泊福及依托咪酯可安全用于ASA分级Ⅰ～Ⅱ级的糖尿病患者的手术麻醉。

Objective To evaluate the effects on the changes of plasma glucose during anesthesia with target controlled infusion（TCI ） system for etomidate or propofol emulsion on diabetic patients. Methods Sixty general anesthesia diabetic patients （ASA Ⅰ - Ⅱ ） undergoing selective operation were randomly divided into group E （etomidate emulsion, 30 cases） and group P （propofol emulsion, 30 cases） with TCI in the whole anesthesia. The plasma glucose was measured at 5 min before anesthesia （T0）, just intubation （T1）, 5 min after intubation （T2）, at the end of the operation （T3） and at 24 h, 48 h postoperation （T4, T5） and measured the changes of systolic blood pressure（SBP）, diastolic bolld pressure（DBP）, heart rate（HR）, pulse oxygen saturation （SpO2） at the corresponding time. Results SBP and DBP at T1 and T2 were （ 110.63 ± 16.92）, （ 108.80± 20.97） mm Hg（ 1 mm Hg = 0.133 kPa）and （66.37 ± 8.00）,（68.60 ± 11.19） mm Hg, HR was （73.77 ± 8.13）,（74.67 ± 8.33 ） times/min in group P which were lower than that at To I（135.01 ＋ 13.45）, （79.37 ＋ 8.58 ） mm Hg and （79.73 ± 9.06） times/min ], P 〈 0.05. SBP and DBP at T1 and T2 in group E were no significantly different from that at To , P 〉 0.05. HR was higher at T2 E （89.20 ± 9.06） times/min ] than that at To [ （80.97 ± 8.91 ） times/min ] in group E, P 〈 0.05. The blood gluscose at T1-T5 was increased in two groups, but there was no significant difference compared with T0, P 〉 0.05. Conclusions Compared with TCI system for propofol, TCI system for etomidate is better stability on hemodynamics in the whole anesthesia. The two drugs have no significant influence on the changes of plasma glucose during anesthesia with TCI system on diabetic patients.