糖尿病手术患者应用全身麻醉和硬膜外麻醉的效果及对血糖水平的影响评价

Evaluation of the Effect of General Anesthesia and Epidural Anesthesia on Blood Glucose Level in Diabetic Patients Undergoing Surgery

目的探讨分别选择全身麻醉、硬膜外麻醉对糖尿病手术(袖状胃成形术)患者产生的作用。方法选取2022年9月—2024年1月北京市大兴区人民医院接收的糖尿病(袖状胃成形术)患者(74例)为研究对象,根据不同麻醉方式将其分成对照组(全身麻醉)、观察组(硬膜外麻醉),各37例,对比两组不同时段的血糖水平、应激指标、麻醉恢复情况。结果手术结束时、手术后3 h,观察组的空腹血糖、心率、收缩压、舒张压水平均低于对照组,差异有统计学意义(P均<0.05)。观察组插管时的促肾上腺皮质激素、去甲肾上腺素、血管紧张素-Ⅱ、β-内啡肽、皮质醇水平低于对照组,差异有统计学意义(P均<0.05)。观察组的自主呼吸恢复、睁眼、气管导管撤管、恢复室停留时间均短于对照组,差异有统计学意义(P均<0.05)。结论在糖尿病手术患者中,实施硬膜外麻醉的麻醉效果优于全身麻醉,并且能够保障患者血糖与体征的稳定,减轻应激反应,利于术后苏醒与康复。

Objective To explore the effects of general anesthesia and epidural anesthesia on patients with diabetic surgery(sleeve gastrectomy).Methods A total of 74 patients with diabetes mellitus(sleeve gastrectomy)admitted to Beijing Daxing District People's Hospital from September 2022 to January 2024 were selected as the research objects.According to different anesthesia methods,they were divided into control group(general anesthesia)and observation group(epidural anesthesia),37 cases in each group.The blood glucose level,stress indexes at different times and anesthesia recovery of the two groups were compared.Results At the end of operation and 3 h after operation,the levels of fasting plasma glucose,heart rate,systolic blood pressure and diastolic blood pressure in the observation group were lower than those in the control group,and the differences were statistically significant(all P<0.05).The levels of adrenocorticotropic hormone,norepinephrine,angiotensin-Ⅱ,β-endorphin and cortisol during intubation in the observation group were lower than those in the control group,and the differences were statistically significant(all P<0.05).The time of spontaneous breathing recovery,eye opening,tracheal tube withdrawal and recovery room stay in the observation group were shorter than those in the control group,and the differences were statistically significant(all P<0.05).Conclusion In patients with diabetic surgery,the anesthetic effect of epidural anesthesia is better than that of general anesthesia,which can ensure the stability of blood glucose and signs,reduce stress response,and facilitate postoperative recovery and rehabilitation.