2型糖尿病胃转流术的麻醉管理

Anesthesia Management of the Gastric Bypass of Type Ⅱ Diabetes

目的探讨一种较为合理可行的麻醉管理模式,为2型糖尿病患者行胃转流术的麻醉管理提供借鉴。方法选择行胃转流术的2型糖尿病患者32例,术前用胰岛素泵注,将血糖控制在11.1 mmol/l以下,术中使用胰岛素调控血糖在12.0 mmol/l以下,血糖在8.6 mmol/l以下不使用胰岛素,麻醉方法选择随机分成两组,硬膜外复合全身麻醉组和全身麻醉组。结果硬膜外复合全身麻醉组患者在术中血糖波动小,血流动力学稳定,术毕清醒快,术中胰岛素使用总量较全身麻醉组明显减少。结论Ⅱ型糖尿病患者行胃转流术,围术期合理调控血糖,麻醉选择硬膜外复合全身麻醉,是一种安全可行的较为合理的麻醉管理模式。

Objective To explore a more reasonable and feasible anesthesia management mode so as to provide a reference for the gastric bypass anesthesia management of patients with type II diabetes. Methods 1. 32 patients with type Ⅱdiabetes underwent gastric bypass were selected. Before the operation, the blood glucose of the patients was controlled below 11.1mmol/l by the insulin pump infusion; the blood glucose of the patients was controlled below 12.0mmol/l except patients whose blood glucose was below 8.6mmol/l during the operation; 2. According to the anesthesia method, the patients were randomly divided into two groups, the general anesthesia combined with epidural block group and general anesthesia group. Results The blood glucose of the general anesthesia combined with epidural block group is smaller, and the hemodynamics is more stable, postoperative awake is quicker and the total dosage of insulin used in the operation is significantly less than that of the general group. Conclusion The general anesthesia combined with epidural block is a kind of safe, feasible and reasonable anesthesia management mode for patients with type II diabetes undergoing gastric bypass surgery and controlling blood glucose during the perioperative period.