丙泊酚与七氟醚对胃癌合并T2MD患者血糖水平及胰岛素水平的影响

Effects of propofol and sevoflurane on blood glucose and insulin levels in patients with gastric cancer complicated with T2MD

目的探讨丙泊酚与七氟醚对胃癌合并T2MD患者的血糖水平及胰岛素水平的影响。方法选择2019年5月~2021年1月71例胃癌合并T2MD患者作为研究对象,所有患者均在气管插管全身麻醉下行胃癌根治术,根据麻醉药的不同将其分为丙泊酚组(n=37)与七氟醚组(n=34)。分别在两组患者麻醉前、手术10 min、手术20 min、手术30 min、术毕、术后30 min检测血糖和胰岛素水平。结果丙泊酚组术毕的血糖水平明显低于七氟醚组,比较差异有统计学意义(P<0.05),其它时点比较差异无统计学意义(P>0.05);丙泊酚组手术20 min的血糖增加值明显多于对照组,比较差异有统计学意义(P<0.05),其它时点比较差异无统计学意义(P>0.05)。丙泊酚组术毕的胰岛素水平明显高于七氟醚组,比较差异有统计学意义(P<0.05),其它时点比较差异无统计学意义(P>0.05);丙泊酚组麻醉前、手术10 min、手术20 min、术毕、术后30 min的胰岛素变化值明显多于七氟醚组,比较差异有统计学意义(P<0.05)。结论胃癌合并T2MD患者术中血糖持续升高,血浆胰岛素亦持续升高,提示这种高血糖反应并非为胰岛素分泌不足导致的结果,而可能与麻醉、手术操作等复杂的应激因素致使胰岛素抵抗加重有关;丙泊酚促进胰岛素分泌的效果较七氟醚更明显,但二者对血糖的影响整体上并无较大差异。

Objective To investigate the effects of propofol and sevoflurane on blood glucose and insulin levels in patients with gastric cancer complicated with T2MD.Methods 71 patients with gastric cancer complicated with T2MD from May 2019 to January 2021 were selected as subjects.All patients underwent radical gastrectomy under tracheal intubation and general anesthesia.They were divided into propofol group(n=37)and sevoflurane group(n=34)according to different anesthetics.The blood glucose and insulin levels were measured before anesthesia,10min after surgery began,20min after surgery began,30min after surgery began,and postoperative 30 min,respectively.Results The postoperative blood glucose level of propofol group was significantly lower than that of sevoflurane group,and the comparison was statistically significant(P<0.05),while comparison of other time points showed no statistical significance(P>0.05).The value added of blood glucose in the propofol group was significantly higher than that in the control group at 20 min,and the comparison was statistically significant(P<0.05),while comparison of other time points showed no statistical significance(P>0.05).The postoperative insulin level of propofol group was significantly higher than that of sevoflurane group,and the comparison was statistically significant(P<0.05),while comparison of other time points showed no statistical significance(P>0.05).The changes of insulin in propofol group before anesthesia,10min after surgery began,20min after surgerybegan,30min after surgery began and postoperative 30 min were significantly higher than those in sevoflurane group,and the comparison was statistically significant(P<0.05).Conclusion In patients with gastric cancer complicated with T2MD,intraoperative blood glucose and plasma insulin continuously increased,suggesting that this hyperglycemia is not the result of insufficient insulin secretion,but may be related to the aggravation of insulin resistance caused by complicated stress factors such as anesthesia and surgical operation.The effect of propofol on promoting insulin secretion was more obvious than that of sevoflurane,but there was no significant difference in the overall effect of the two on blood glucose.