复旦学报（医学版）
複旦學報（醫學版）
복단학보（의학판）
FUDAN UNIVERSITY JOURNAL OF MEDICAL SCIENCES
2009年
6期
753-756
,共4页
王慧琳%葛宁花%葛圣金%薛张纲
王慧琳%葛寧花%葛聖金%薛張綱
왕혜림%갈저화%갈골금%설장강
葡萄糖%胰岛素%代谢%围手术期%体温
葡萄糖%胰島素%代謝%圍手術期%體溫
포도당%이도소%대사%위수술기%체온
glucose%insulin%metabolism%perioperative period%body temperature
目的 研究术中静脉输注葡萄糖和胰岛素对在硬膜外阻滞复合全麻下行剖胸食管癌手术患者物质能量代谢的影响.方法 选择限期于硬膜外阻滞复合全麻下行剖胸食管癌手术患者20例,ASA Ⅰ～Ⅱ级,年龄25～60岁,性别不限,随机分为干预组和对照组,各10例.干预组于外科切皮起输注50%葡萄糖(glucose,Glu)溶液(0.5 g·kg~(-1)·h~(-1))和正规胰岛素(regular insulin,RI,初始剂量为Glu ∶ RI=1 g ∶ 1～1.5 IU,之后按测得的血糖调整胰岛素用量)直至手术结束;对照组则输注等容量生理盐水.监测直肠温度、血糖、血浆游离脂肪酸(free fatty acid,FFA)、血钾及术后24 h尿素氮定量.结果 两组患者直肠温度均呈下降趋势,组间差别无统计学意义.对照组血糖浓度在术始至术后2 h逐渐升高;干预组术中血糖浓度较术前有所升高,术后1、2h血糖浓度与术前相比无统计学差异.干预组血浆FFA浓度与对照组相比,在术中30、90、120、150 min及术后2h显著降低(P<0.05).干预组术中1、2 h及术后1、2 h血钾浓度与术前相比均有显著下降.术后24 h尿素氮定量两组间无统计学差异.结论 对于硬膜外阻滞复合全麻下行剖胸食管癌手术的患者,术中输注葡萄糖和胰岛素不能减轻术中深部体温下降,但是可能有抑制脂肪分解的作用.
目的 研究術中靜脈輸註葡萄糖和胰島素對在硬膜外阻滯複閤全痳下行剖胸食管癌手術患者物質能量代謝的影響.方法 選擇限期于硬膜外阻滯複閤全痳下行剖胸食管癌手術患者20例,ASA Ⅰ～Ⅱ級,年齡25～60歲,性彆不限,隨機分為榦預組和對照組,各10例.榦預組于外科切皮起輸註50%葡萄糖(glucose,Glu)溶液(0.5 g·kg~(-1)·h~(-1))和正規胰島素(regular insulin,RI,初始劑量為Glu ∶ RI=1 g ∶ 1～1.5 IU,之後按測得的血糖調整胰島素用量)直至手術結束;對照組則輸註等容量生理鹽水.鑑測直腸溫度、血糖、血漿遊離脂肪痠(free fatty acid,FFA)、血鉀及術後24 h尿素氮定量.結果 兩組患者直腸溫度均呈下降趨勢,組間差彆無統計學意義.對照組血糖濃度在術始至術後2 h逐漸升高;榦預組術中血糖濃度較術前有所升高,術後1、2h血糖濃度與術前相比無統計學差異.榦預組血漿FFA濃度與對照組相比,在術中30、90、120、150 min及術後2h顯著降低(P<0.05).榦預組術中1、2 h及術後1、2 h血鉀濃度與術前相比均有顯著下降.術後24 h尿素氮定量兩組間無統計學差異.結論 對于硬膜外阻滯複閤全痳下行剖胸食管癌手術的患者,術中輸註葡萄糖和胰島素不能減輕術中深部體溫下降,但是可能有抑製脂肪分解的作用.
목적 연구술중정맥수주포도당화이도소대재경막외조체복합전마하행부흉식관암수술환자물질능량대사적영향.방법 선택한기우경막외조체복합전마하행부흉식관암수술환자20례,ASA Ⅰ～Ⅱ급,년령25～60세,성별불한,수궤분위간예조화대조조,각10례.간예조우외과절피기수주50%포도당(glucose,Glu)용액(0.5 g·kg~(-1)·h~(-1))화정규이도소(regular insulin,RI,초시제량위Glu ∶ RI=1 g ∶ 1～1.5 IU,지후안측득적혈당조정이도소용량)직지수술결속;대조조칙수주등용량생리염수.감측직장온도、혈당、혈장유리지방산(free fatty acid,FFA)、혈갑급술후24 h뇨소담정량.결과 량조환자직장온도균정하강추세,조간차별무통계학의의.대조조혈당농도재술시지술후2 h축점승고;간예조술중혈당농도교술전유소승고,술후1、2h혈당농도여술전상비무통계학차이.간예조혈장FFA농도여대조조상비,재술중30、90、120、150 min급술후2h현저강저(P<0.05).간예조술중1、2 h급술후1、2 h혈갑농도여술전상비균유현저하강.술후24 h뇨소담정량량조간무통계학차이.결론 대우경막외조체복합전마하행부흉식관암수술적환자,술중수주포도당화이도소불능감경술중심부체온하강,단시가능유억제지방분해적작용.
Objective To study the effect of intraoperative glucose and insulin infusion on the metabolism in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block. Methods Twenty ASA physical status Ⅰ-Ⅱ adult patients undergoing esophageal cancer surgery were studied. Ten patients received an iv glucose infusion at 0.5 g·kg~(-1)·h~(-1) and insulin infusion (1-1.5 IU ∶ 1 g glucose) throughout the anesthesia. Ten control subjects received isovolumic nutrient-free saline solution. Rectal temperature, plasma glucose concentrations, plasma free fatty acid (FFA) concentrations, plasma potassium concentrations and 24 hour urea nitrogen were measured perioperatively. Results No statistical difference was observed in rectal temperature and 24 hour urea nitrogen between the two groups. The plasma glucose concentrations continued to increase perioperatively in the control group. The glucose concentration increased during the operation in the glucose/insulin group, but the glucose concentrations at 1 and 2 hours after the operation were not statistically different from that before operation. Significant difference in plasma FFA concentration was found perioperatively (30, 90, 120, 150 min during the operation compared with 1 h after operation) between the two groups. In the glucose/insulin group, there was a significant decrease in the concentration of plasma potassium at 1 and 2 h during and after the operation. Conclusions Intraoperative glucose and insulin infusion cannot prevent hypothermia in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block, however, it may reduce lipoclasis.
