舒芬太尼或瑞芬太尼复合异丙酚麻醉对糖尿病患者血糖及血浆胰岛素水平影响

Effects of Sufentanil or Remifentanil Combined with Propofol Administration on Blood Glucose and Insulin during Surgery in Diabetic Patients

目的比较舒芬太尼、瑞芬太尼复合异丙酚麻醉对糖尿病手术患者术中、术后血糖及血浆胰岛素水平的影响。方法将60例Ⅰ-Ⅱ级(美国麻醉医师协会分级标准)合并糖尿病的耳鼻喉科手术患者随机分为A、B组,每组各30例。A组术中采用舒芬太尼复合异丙酚全身麻醉,B组采用瑞芬太尼复合异丙酚全身麻醉。分别对两组患者于麻醉前、插管后、手术30min、术毕、术后2h、6h抽取的静脉血进行血糖及血浆胰岛素测定。结果 A组患者术中、术后血糖与麻醉前相比差别无统计学意义(P>0.05),而B组患者手术30min、术毕、术后2h、6h血糖较麻醉前增高(P<0.05),且两组间差异具有统计学意义(P<0.05)。两组患者的术后空腹血浆胰岛素水平较术前升高(P<0.05),两组间差异无统计学意义(P>0.05)。结论同瑞芬太尼相比,舒芬太尼对糖尿病手术患者的血糖影响较小,更适合糖尿病患者手术麻醉。

Objective To compare the effects of Sufentanil or Remifentanil combined with propofol administration on blood glucose and insulin during surgery under general anesthesia in diabetic patients. Methods Sixty diabetic patients with degree I- II of physical status by ASA standards, who were taking ENT surgery under general anesthesia, were randomized divided into two groups, 30 cases in group A and 30 cases in group B. Under general anesthesia, the patients in group A were intravenously injected Sufentanil combined with propofol, in group B injected Remifentanil combined with propofol. Blood samples were taken for the measurement of glucose and insulin before induction of anesthesia, after intubation, at 30min beginning the surgery, at the surgery over and at 2h and 6h after surgery. Results Compared with that before anesthesia, blood glucose in group A was not significantly increased during the surgery or after surgery （P〉0.05）; but in group B, glucose significantly increased since 30min beginning surgery to 6h after surgery （P〈0.05）, and the differences between the two groups were significant（P〈0.05）. Blood insulin significantly increased after surgery compared with that before surgery in both groups（P〈0.05）, which were not statistically different between the two groups （P〉0.05）. Conclusion Compared with Remifentanil, Sufentanil combined with propofol could keep less effect on glucose and less increase of insulin resistance, which more fitful to the diabetic patients with surgery.