椎管内麻醉下妇科开腹手术患者血流动力学及血糖变化研究

Study on the hemodynamics and blood sugar changes of gynecological laparotomy under intravertebral anesthesia

目的观察椎管内麻醉下糖尿病及血糖正常妇科开腹手术患者血流动力学及血糖变化。方法选择60例妇科开腹手术患者,其中糖尿病患者30例﹙Ⅰ组﹚,血糖正常患者30例﹙Ⅱ组﹚。记录患者术前24 h(T_1)、入室(T_2)、切皮前(T_3)、切皮1 h(T_4)、术后2 h(T_5)、术后24 h(T_6)的SBP、DBP、HR及血糖浓度。结果两组患者各时点SBP、DBP、HR情况比较,差异无统计学意义(P均>0.05),两组T_3时点SBP、DBP比T_2时点低,血糖正常患者T_4、T_5时点血糖值明显高于T_1时点,糖尿病患者T_4、T_5、T_6时点血糖值明显高于T1时点(P<0.05)。结论手术应激引起血糖变化高峰在术中及术后几小时内,并且术后糖尿病患者血糖回落迟缓,腹部手术选择椎管内麻醉能有效控制应激反应,保证患者围术期安全。

Objective To observe the hemodynamics and blood sugar changes in the patients with diabetes and normal blood sugar receiving gynecological laparotomy under intravertebral anesthesia. Methods 60 patients receiving gynecological laparotomy were selected, with 30 patients with diabetes（group Ⅰ） and 30 patients with normal blood sugar （group Ⅱ）. SBP, DBP, HR and concentration of blood sugar 24 h before the surgery（T1）, during entering room （T2）, before skin incision（T3）, 1 h after skin incision （T4）, 2 h after the surgery （T5）, and 24 h after the surgery （T6） were recorded. Results There were no differences of SBP, DBP and HR at all time points compared between the two groups （P〉0.05）. SBP and DBP at T3 in the two groups were lower than those at T2. Blood sugar value in the patients with normal blood sugar 1 h after skin incision and 2 h after the surgery was significantly higher than that 24 h before the surgery, and the blood sugar value in the patients with diabetes 1 h after skin incision, 2 h after the surgery and 24 h after the surgery were significantly higher than that 24 h before the surgery （P〈0.05）. Conclusion Surgical stress induces blood sugar peak during the surgery and several hours after the surgery, and blood sugar falling is slow in the patients with diabetes after the surgery. Intravertebral anesthesia in laparotomy is able to effectively control the stress reactions, and ensures the perioperative period of the patients.