七氟烷或丙泊酚复合瑞芬太尼对全麻患者血糖和胰岛素敏感性的影响

发布时间：2018-01-28 08:33

本文关键词： 七氟烷丙泊酚瑞芬太尼血糖胰岛素敏感性　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察七氟烷或丙泊酚复合瑞芬太尼对全麻患者血糖和胰岛素敏感性的影响。方法:择期在全麻下行腰椎手术的患者40例,ASAⅠ~Ⅱ级,性别不限,年龄18~60岁,体重指数18~25kg/m2,随机分为两组:七氟烷复合瑞芬太尼组(SR组,n=20)和丙泊酚复合瑞芬太尼组(PR组,n=20)。SR组静脉注射咪达唑仑0.05mg/kg,舒芬太尼0.3~0.4ug/kg,苯磺顺阿曲库铵0.2mg/kg并通过面罩吸入6%七氟烷行麻醉诱导,PR组静脉注射丙泊酚1.5mg/kg代替七氟烷吸入,余用药同SR组行麻醉诱导。术中SR组吸入1.5%~2.5%七氟烷复合瑞芬太尼0.25~0.5μg·kg-1·min-1持续静脉泵注维持麻醉,PR组持续静脉泵注丙泊酚4~12mg·kg-1·h-1复合瑞芬太尼0.25~0.5μg·kg-1·min-1维持麻醉。术中控制BIS值在40~60,测定两组患者麻醉前(T_0)、气管插管后5min(T_1)、术中1h(T_2)、术中2h(T_3)、拔出气管导管后15min(T_4)肘静脉血中葡萄糖(Glu)、C肽、胰岛素(Ins)、皮质醇(Cor)浓度,用公式计算胰岛素敏感指数(ISI)和抵抗指数(IRI),并记录两组患者五个时间点的HR、MAP、BIS值、腋窝温度的变化以及血糖异常(偏离正常值)的发生例数。结果:(1)两组患者一般资料比较,差异无统计学意义(P0.05);(2)两组患者同一时间点的HR、MAP、BIS值和腋窝温度比较,差异无统计学意义(P0.05);与T_0时间点比较,两组患者在T_1、T_2、T_3时间点的HR、MAP、BIS值均下降(P0.05);T_4时间点上升接近于T_0水平(P0.05);(3)两组患者在T_0、T_1时间点的Glu、Ins和C肽比较,差异无统计学意义(P0.05),在T_2、T_3、T_4时间点,PR组的Glu低于SR组(P0.05),Ins和C肽高于SR组(P0.05);同一时间点两组患者的Cor、ISI和IRI比较,差异无统计学意义(P0.05)。组内比较,SR组患者在T_1间点的Glu、Cor较T_0时间点降低(P0.05),在T_2、T_3、T_4时间点,Glu、Ins、C肽、ISI和IRI与T_0时间点比较,差异无统计学意义(P0.05);PR组在T_1、T_2、T_3、T_4时间点的Glu、Cor均较T_0时间点低(P0.05),在T_1时间点的Ins和C肽与T_0时间点比较,差异无统计学意义(P0.05),但在T_2、T_3、T_4时间点的Ins和C肽较T_0和T_1时间点升高(P0.05);ISI和IRI与T_0时间点比较,差异无统计学意义(P0.05);(4)两组患者血糖异常的发生率比较,差异无统计学意义(P0.05)。结论:七氟烷或丙泊酚复合瑞芬太尼全麻均不影响胰岛素敏感性,但丙泊酚复合瑞芬太尼全麻有促进胰岛素分泌趋势,使术中和苏醒期的血糖相对较低。
[Abstract]:Objective: to observe the effect of sevoflurane or propofol combined with remifentanil on blood glucose and insulin sensitivity in patients with general anesthesia. Age 1860, BMI 1825 kg / m2, were randomly divided into two groups: sevoflurane combined with remifentanil group (n = 20) and propofol combined with remifentanil group (n = 20) or propofol combined with remifentanil group (n = 20). Midazolam was injected intravenously with midazolam 0.05 mg / kg and sufentanil 0.3g / kg per kg in SR group. Benzenesulfonate cis-atracurium 0.2mg / kg and 6% sevoflurane were inhaled through the mask. Propofol 1.5 mg / kg was injected intravenously in group PR instead of sevoflurane. Anesthetic induction was performed in SR group. Anesthesia was maintained by continuous intravenous infusion of 1.5% sevoflurane combined with remifentanil 0.25 渭 g 路kg-1 路min-1 during the operation in SR group. In PR group, intravenous infusion of propofol 4mg 路kg-1 路h-1 and remifentanil 0.250.5 渭 g 路kg-1 路min-1 was used to maintain anesthesia. BIS was controlled at 40 渭 g 路h -1 during operation. Con 60. The patients in both groups were measured before anesthesia, 5 min after tracheal intubation, 1 hour after operation, 1 hour after operation, 2 hours after operation, and 2 hours after operation. The concentration of Glu-C peptide, insulin Insna and cortisol in the blood of elbow vein was 15 min after trachea catheter was pulled out. The insulin sensitivity index (ISI) and the resistance index (IRI) were calculated by the formula, and the BIS values of HRG MAPV were recorded at five time points in the two groups. The change of axillary temperature and the occurrence of abnormal blood glucose (deviate from normal value). Results there was no significant difference in general data between the two groups (P 0.05). (2) there was no significant difference between the BIS value of HRP MAPV and the axillary temperature in the two groups at the same time point (P 0.05). Compared with T0 time point, the BIS values of HRP MAPV in T1 / T _ 2 / T _ 2 / T _ 3 were decreased in both groups (P < 0.05) at the time point of T _ 1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3. The increase of T4 time point was close to that of T _ 0 level (P _ 0.05); (3) there was no significant difference in Gluin ins and C peptide between the two groups at the time point of T _ 2 / T _ 1, but there was no significant difference between the two groups at the time point of T _ 2 / T _ T _ 3 / T _ 4. The Glu of PR group was lower than that of SR group (P 0.05) and C peptide was higher than that of SR group (P 0.05). There was no significant difference in Cortex ISI and IRI between the two groups at the same time point. The Glu of SR group was compared with that of SR group at T 1 point. Cor was lower than T _ 0 in time point (P _ 0.05) and compared with T _ 0 at T _ S _ 2T _ 3 / T _ T _ 4 / T _ S _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I to T _ T _ 0 time point. The difference was not statistically significant (P 0.05). The Glu-Cor of PR group at T _ 1 / T _ 2 / T _ 3 / T _ S _ 4 time point was lower than that of T _ 0 / T _ (0) (P < 0.05). There was no significant difference between the Ins and C peptide at T _ 1 and T _ 0, but there was no significant difference in T _ (2) / T _ (3) between T _ (1) and T _ (0). The levels of Ins and C-peptide at T _ 4 time point were higher than those at T _ (0) and T _ S _ (1) time points (P = 0.05). There was no significant difference between ISI and IRI in time points compared with that in T _ (0) group (P 0.05). Conclusion: sevoflurane or propofol combined with remifentanil has no effect on insulin sensitivity. However, propofol combined with remifentanil has a tendency to promote insulin secretion and lower blood glucose during operation and recovery.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614.2

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