血糖控制程度与老年糖尿病手术病人顺式阿曲库铵肌松效果的相关性

Effect of glycemic control degree on cisatracurium-induced neuromusculaRblock in elderly diabetic patients undergoing general anesthesia during perioperative period

目的探讨血糖控制程度对老年糖尿病病人全麻围术期顺式阿曲库铵的神经肌肉阻滞效果的影响。方法选择150例本院全麻外科手术治疗的老年糖尿病病人,根据病人HbA1c水平分为控制良好组(88例,HbA1c≤6.0%)与控制不良组(62例,HbA1c>6.0%)。另选择我院同期接受全麻手术血糖及HbA1c正常的老年病人70例作为对照组。静脉麻醉诱导后予以顺式阿曲库铵0.15 mg/kg,监测病人神经肌肉阻滞程度。比较2组起效时间、临床作用时间、肌抽搐最大抑制程度、临床恢复时间、恢复指数和90%恢复指数等指标的差异。Pearson相关分析评估HbA1c与上述各指标的相关性。多元Logistic回归分析老年糖尿病病人神经肌肉阻滞的影响因素。结果控制不良组起效时间最短,临床作用时间、肌抽搐最大抑制程度、临床恢复时间、恢复指数和90%恢复指数最长(P<0.05);对照组与控制良好组的HbA1c、起效时间与肌抽搐最大抑制程度差异无统计学意义(P>0.05),但控制良好组的临床作用时间、临床恢复时间、恢复指数和90%恢复指数均较对照组更长(P<0.05)。Pearson相关分析显示,老年糖尿病病人HbA1c水平与临床作用时间、恢复指数和90%恢复指数呈正相关(R=0.825,P=0.025;R=0.725,P=0.047;R=0.802,P=0.030),而与起效时间呈负相关(R=-0.819,P=0.032)。多元Logistic回归分析显示,HbA1c为老年糖尿病病人神经肌肉阻滞的独立影响因素(OR=2.895,P=0.024)。结论老年糖尿病病人血糖控制不良会增强全麻围术期顺式阿曲库铵的神经肌肉阻滞效果,抑制肌松恢复,且血糖控制越差,神经肌肉阻滞越显著。

Objective To analyze the effect of the degree of glycemic control on cisatracurium-induced neuromusculaRblock in the elderly diabetic patients undergoing general anesthesia during perioperative period.Methods A total of 150 elderly patients with diabetes mellitus receiving operation undeRgeneral anesthesia in ouRhospital were enrolled and divided into good-control group(n=88,HbA1c≤6.0%)and poor-control group(n=62,HbA1c>6.0%)according to the value of glycated hemogloglobin(HbA1c)during perioperative period.Seventy contemporary elderly patients without diabetes mellitus who received the operations undeRgeneral anesthesia were selected as control group.AfteRinduction of intravenous anesthesia,all patients received intravenous cisatracurium 0.15 mg/kg,and the degree of neuromusculaRblock was monitored.The onset time,clinical action time,maximum inhibition degree of muscle convulsions,clinical recovery time,recovery index and 90%recovery index were compared among the three groups.The correlations of HbA1c with the above indexes were analyzed by Pearson lineaRcorrelation analysis.The risk factors of neuromusculaRblock in the elderly diabetic patients were investigated by multivariate Logistic analysis.Results Compared with the otheRtwo groups,the onset time was shorteRand the levels of clinical action time,maximum inhibition degree of muscle convulsions,clinical recovery time,recovery index and 90%recovery index in the poor-control group were higher(P<0.05).There were no signifcant differences in the level of HbA1c,onset time and maximum inhibition degree of muscle convulsions between the good-control group and the control group(P>0.05).But the clinical action time,clinical recovery time,recovery index and 90%recovery index of the good-control group were higheRthan those in the control group(P<0.05).The level of HbA1c was positively correlated with clinical action time,recovery index and 90%recovery index(R=0.825,P=0.025;R=0.725,P=0.047;R=0.802,P=0.030),and negatively correlated with onset time(R=-0.912,P=0.009).Multivariate Logistic analysis showed that HbA1c was an independent risk factoRof neuromusculaRblock in the elderly diabetic patients undergoing general anesthesia(OR=2.895,P=0.024).Conclusions High glycemic level can enhance the cisatracurium-induced neuromusculaRblock in general anesthesia during perioperative period,and inhibit the recovery of the muscle relaxation.