硬膜外麻醉对糖尿病患者血液流变学和血浆胰岛素及血糖水平的影响

Effect of epidural anesthesia on hemorheology,plasma insulin and glucose in diabetic patients

目的:探讨硬膜外麻醉对糖尿病患者血液流变学、血浆胰岛素及血糖水平的影响。方法:选择2015年10月—2016年10月住院的2型糖尿病行腹部手术治疗的患者160例,分为硬膜外阻滞麻醉组和全身麻醉组,每组80例,对比两组麻醉前后血液流变学指标、血浆胰岛素及血糖水平。结果:两组麻醉前全血低切黏度、全血高切黏度、血浆黏度、红细胞聚集指数比较,差异无统计学意义(P>0.05)。硬膜外麻醉组麻醉后相关指标水平明显低于全身麻醉组,差异有统计学意义(P<0.05);两组手术30min、术后即刻及术后4h血浆胰岛素水平明显高于麻醉前(P<0.05),与全身麻醉组比较,硬膜外麻醉组血浆胰岛素水平增高更明显;硬膜外麻醉组手术30 min、术后即刻血糖水平均明显高于麻醉前(P<0.05),在术后4 h血糖水平恢复至麻醉前水平。全身麻醉组手术30 min、术后即刻及术后血糖水平均明显高于麻醉前(P<0.05)。组间比较,硬膜外麻醉组手术30 min、术后即刻、术后4 h血糖水平低于全身麻醉组(P<0.05)。结论:对糖尿病患者采用硬膜外麻醉方式可以使血液流变学相关参数降低,改善胰岛素分泌,保持血糖水平的相对稳定。

Objective: To investigate the effect of epidural anesthesia on hemorheology,plasma insulin and blood glucose in diabetic patients. Methods: A total of 160 patients undergoing type Ⅱ diabetes hospitalized for abdominal surgery from October 2015 to October 2016 were selected and divided into epidural anesthesia group and general anesthesia group,80 cases in each group. The hemorheology,plasma insulin and blood glucose levels of two groups were compared before and after anesthesia. Results: There was no significant difference in low-cut whole blood viscosity,whole-blood high-cut viscosity,plasma viscosity and erythrocyte aggregation index before anesthesia in both groups( P > 0. 05). Epidural anesthesia group after anesthesia related indicators were significantly lower than the general anesthesia group,the difference was statistically significant( P < 0. 05). The levels of plasma insulin in the two groups were significantly higher than those before anesthesia( P < 0. 05)at 30 min,immediately after operation and 4 h after operation. Compared with the general anesthesia group,the plasma insulin level increased more significantly in the epidural group. Compared with general anesthesia group,epidural anesthesia group increased plasma insulin levels of more obvious; 30 min,postoperative epidural anesthesia group immediately blood significantly better than the average before anesthesia( P < 0. 05),4 h blood glucose levels after surgery to restore to the level before anesthesia. General anesthesia group 30 min,immediately after surgery and postoperative blood glucose levels were significantly higher than before anesthesia( P < 0. 05). Comparison between groups,epidural anesthesia group 30 min,immediately after surgery,postoperative 4 h blood glucose level is lower than the general anesthesia group( P < 0. 05). Conclusion: Using epidural anesthesia in patients with diabetes mellitus can lower the blood rheological parameters,improve insulin secretion,keep the blood sugar level is relatively stable.