糖尿病对老年病人行开腹手术时术中血糖的影响

Influence of diabetes on blood glucose response in the elderly patients with laparotomy

目的研究糖尿病对老年病人行开腹手术时术中血糖的影响。方法纳入153例择期行开腹手术的病人,性别不限,年龄60~80岁,美国麻醉医师协会(ASA)分级Ⅱ~Ⅳ级,根据术前有无糖尿病病史分为非糖尿病组与糖尿病组。分别于诱导前、切皮后、手术1 h、手术2 h、手术3 h、手术结束时抽取静脉血,使用罗氏活力型血糖仪及配套罗氏血糖试纸测量各时点血糖值并进行比较。血糖浓度超过11.1 mmol/L时,使用胰岛素0.1 U/(kg·h)泵注进行治疗。结果纳入本研究的所有老年病人,在整个手术过程中,从术前基础状态到切皮后血糖浓度轻度增加,从切皮后到手术2 h术中血糖明显增加,保持一个较稳定的水平直至手术结束。糖尿病组与非糖尿病组病人术中平均血糖水平分别为(7.8±2.0)mmol/L和(6.7±1.0)mmol/L,差异有统计学意义(P<0.001)。糖尿病组与非糖尿病组病人术中最大血糖变化量(即术前基础血糖到术中峰值血糖的差值)分别为(1.8±1.6)mmol/L与(2.6±1.6)mmol/L,差异有统计学意义(P=0.009),糖尿病及术中使用胰岛素是术中最大血糖变化量的影响因素。结论老年病人行开腹手术时术中血糖均明显升高,术中高血糖反应与手术的不同阶段有关。糖尿病病人最大血糖变化量明显低于非糖尿病病人,这可能与糖尿病病人的应激能力减弱有关。

Objective To investigate the influence of diabetes on blood glucose response during abdominal operation in the elderly patients. Methods One hundred and fifty-three patients（ aged 60-80） with an American Society of Anesthesiologists physical status of Ⅱ-Ⅳ scheduled for major abdominal surgery under general anesthesia were enrolled. They were divided into two groups according to whether suffering from diabetes or not. Blood samples from the vein were collected before induction,immediately after incision,1 h after surgery,2 h after surgery,3 h after surgery,and at the end of surgery. Accu-Chek device was used to measure the blood glucose concentration. Insulin [0. 1 U/（ kg·h） ] was given when blood glucose concentrations exceeded 11. 1 mmol/L to maintain the blood glucose at the level of3. 9-11. 1 mmol/L. Results In all patients,the mean glucose increased slightly from preoperative baseline to incision,and obviously from incision to 2 h after operation,and then remained at a high and fairly stable level through the operation. The intraoperative mean blood glucose was 7. 8±2. 0 mmol/L in diabetic patients and 6. 7 ± 1. 0 mmol/L in non-diabetic patients（ P〈0. 001）. The average change from preoperative to maximal intraoperative glucose concentration was 1. 8 ± 1. 6 mmol/L in diabetic patients and 2. 6 ± 1. 6 mmol/L in non-diabetic patients（ P = 0. 009）. Diabetes and the use of insulin were influencing factors of maximal intraoperative glucose concentration. Conclusions In aged patients undergoing major abdominal operation,intraoperative blood glucose is significantly increased during operation. Diabetes may influence the maximal glucose change.