术中静脉使用胰岛素对女性肥胖伴胰岛素抵抗患者糖代谢的影响

Effect of insulin intravenous infusion during operation on glucose metabolism in obese woman patients with insulin resistance

目的 了解女性肥胖伴胰岛素抵抗患者麻醉和手术中血糖和血浆胰岛素水平的变化,以及术中静脉滴注胰岛素对其影响.方法 20例女性肥胖伴胰岛素抵抗的择期手术患者,ASAI—Ⅱ级,随机分成2组,B组术中静脉滴注无糖溶液;C组使用含糖溶液加胰岛素静脉滴注,每4g葡萄糖用1U胰岛素,胰岛素总量控制在20U,其余液体使用无糖溶液;另设10例无胰岛素抵抗患者作为对照组(A组),分别于麻醉前、麻醉后、术中(手术进行30min)和未毕测定血糖和血浆胰岛素水平.结果 女性肥胖患者均存在胰岛素抵抗现象,表现为空腹血糖水平和血浆胰岛素水平较对照组明显升高,麻醉和手术应激均使血糖和血浆胰岛素水平升高,术中静脉滴注胰岛素可防止血糖升高.结论 女性肥胖患者存在胰岛素抵抗现象,术中适当使用胰岛素可纠正手术应激对其糖代谢的影响.

Aim The changes of the levels of blood sugar and plasma insulin in obese woman pa-tients with insulin resistance and the effect of insulin intravenous infusion during oper-ation were observed. Methods 10 patients of normal weight(contrast group, group A)and 20 patients of obesity women(ASA grade Ⅰ- Ⅱ) undergoing selective surgerywere investigated. The patients of obesity were randomly divided into two groups(group B and C, respectively). Groups A and B liquids without glucose, and in group Ctransfuse liquids with glucose and insulin(4g glucose add 1U insulin) were transfusedduring operation. The levels of blood sugar and plasma insulin were measured beforeand after anesthesia, during operation(30min) and after operation respectively. ResultsThere was an insulin resistance phenomenon in patients with obesity. The levels ofblood sugar and plasma insulin in patients with obesity were remarkably higher thanthose in patients of normal weight. The levels of blood sugar and plasma insulin wereextremely raised after anesthesia and during operation. The levles of blood sugar wasinhibited as insulin was infused during operation, but no hypoglycemic reaction wasfound. Conclusion There are insulin resistance phenomenon in patients with obesity.Insulin infused during operation can prevent blood sugar rise and minimize glucosemetabolism turbulence.