CAJ | 학술논문

目的评价糖尿病因素对结肠癌根治术肠道准备期血浆渗透压变化的影响.方法择期结肠癌根治术患者60例,ASA分级Ⅰ或Ⅱ级,年龄40 ～ 60岁,体重50 ～ 75 kg,其中2型糖尿病患者30例作为试验组(DM组),非糖尿病患者30例作为对照组(C组).术前肠道准备均采用口服复方聚乙二醇电解质散,于术前准备当日清晨(T1)、入手术室开放静脉前(T2)分别取静脉血样,测定血浆胶体渗透压(COP)及电解质(Na+、Cl-、K+)浓度和血糖浓度;采用视觉模拟评分法确定患者渴感程度.结果与T1时比较,T2时2组血浆COP及渴感程度均升高,DM组血糖浓度降低(P＜0.05),2组血浆电解质浓度差异无统计学意义(P＞0.05);与C组比较,DM组T1,2时血糖浓度升高(P＜0.05),血浆电解质浓度差异无统计学意义,T1时血浆COP及渴感程度差异无统计学意义(P＞0.05),T2时渴感程度降低而血浆COP升高(P＜0.05).结论结肠癌根治术前肠道准备后,尽管糖尿病患者渴感较低,但血浆COP升高更为明显,因此麻醉前需要补充晶体液,不宜输注胶体液,以防高渗性昏迷发生.
목적 평개당뇨병인소대결장암근치술장도준비기혈장삼투압변화적영향.방법 택기결장암근치술환자60례,ASA분급Ⅰ혹Ⅱ급,년령40 ～ 60세,체중50 ～ 75 kg,기중2형당뇨병환자30례작위시험조(DM조),비당뇨병환자30례작위대조조(C조).술전장도준비균채용구복복방취을이순전해질산,우술전준비당일청신(T1)、입수술실개방정맥전(T2)분별취정맥혈양,측정혈장효체삼투압(COP)급전해질(Na+、Cl-、K+)농도화혈당농도;채용시각모의평분법학정환자갈감정도.결과 여T1시비교,T2시2조혈장COP급갈감정도균승고,DM조혈당농도강저(P＜0.05),2조혈장전해질농도차이무통계학의의(P＞0.05);여C조비교,DM조T1,2시혈당농도승고(P＜0.05),혈장전해질농도차이무통계학의의,T1시혈장COP급갈감정도차이무통계학의의(P＞0.05),T2시갈감정도강저이혈장COP승고(P＜0.05).결론 결장암근치술전장도준비후,진관당뇨병환자갈감교저,단혈장COP승고경위명현,인차마취전수요보충정체액,불의수주효체액,이방고삼성혼미발생.
Objective To evaluate the influence of diabetes mellitus on changes in plasma osmotic pressure during bowel preparation in patients undergoing radical resection for colon cancer.Methods Sixty patients,of ASA physical status Ⅰ or Ⅱ,aged 40-60 yr,weighing 50-75 kg,scheduled for elective radical resection for colon cancer,were included in the study.Of the 60 patients,30 patients with type 2 diabetes mellitus served as test group (group DM),and 30 patients without diabetes mellitus served as control group (group C).Polyethylene glycol electrolyte powder was given orally for bowel preparation before surgery.In the early morning of the day on which preoperative preparation was performed (T1) and before opening venous channels after admission to the operating room (T2),venous blood samples were taken for determination of plasma colloid osmotic pressure (COP) and concentrations of plasma electrolytes (Na+,Cl-,K+) and blood glucose.Thirst was assessed using visual analogue scales at T1 and T2.Results Compared with the baseline value at T1,the plasma COP and degree of thirst were significantly increased at T2 in C and DM groups,blood glucose concentrations were decreased at T2 in group DM,and no significant changes were found in the plasma concentrations of electrolytes at T2 in both groups.Compared with group C,blood glucose concentrations were significantly increased,and no significant changes were found in the plasma concentrations of electrolytes at T1,2,no significant change was found in plasma COP and degree of thirst at T1,and the degree of thirst was decreased at T2,while the plasma COP was increased at T2 in group DM.Conclusion After bowel preparation in patients undergoing radical resection for colon cancer,although the thirsty sensation of the patients with diabetes mellitus is decreased,the plasma COP is obviously increased; thus infusion of appropriate crystalloid solution instead of colloid solution is required in case hyperosmolar coma develops.