地塞米松对Ⅱ型糖尿病和非糖尿病开颅手术患者术中血糖的影响

发布时间：2018-09-10 12:25

【摘要】：目的：观察术前单次静脉注射小剂量地塞米松对II型尿病患者（T2DM）和非糖尿病患者在开颅手术中血糖的影响和术后镇痛效果，比较两类患者术中血糖变化情况，，探讨此类患者术中行血糖监测的必要性。方法：择期行颅内动脉瘤夹闭术的患者60例，ASA I或II级，年龄18-60岁，Hunt-Hess分级为I或II级。II型糖尿病患者30例，非糖尿病患者30例。术前检查无重要脏器功能障碍者，如心、肝、肾功能不全者，无贫血，Hb＜11g·dL-1；无长期使用糖皮质激素药物史，试验药物禁忌症，对镇静或镇痛药物无成瘾或依赖性；糖尿病患者符合II型糖尿病诊断标准。随机将T2DM患者分成地塞米松组（DD组，n=15）和生理盐水组（DS组，n=15），同样将非糖尿病患者随机分为地塞米松组（ND组，n=15）和生理盐水组（NS组，n=15）。DD组和ND组，分别于麻醉诱导前30min静脉注射地塞米松10mg（2ml），DS组和NS组，分别于麻醉诱导前30min静脉注射生理盐水2ml。各组分别于给药前，给药后60min、120min、180min、240min采左侧桡动脉血进行血糖分析，并计算各组患者平均血糖升高幅度，用最大血糖值与基础值的差值表示。维持患者术中循环的稳定，T2DM术中血糖控制目标为5.0-11.0mmol·L-1，非糖尿病患者控制术中血糖3.9-8.3mmol·L-1。如血糖低于目标下限，输注5%的葡萄糖液纠正；血糖高于目标上限，给予胰岛素治疗。结果：组内比较，给予地塞米松120min，DD组和ND组术中血糖较术前均明显升高（P0.05），且持续至用药后240min；DS组和NS组，各时间点血糖与基础值之间差异无统计学意义。组间比较，在给药后120min，ND组血糖明显高于NS组（P 0.05），至给药后240min；给药后180min、240min,DD组与DS组比较，血糖显著升高（P 0.05）。非糖尿病患者，ND组血糖升高幅度明显高于NS组（P 0.05）。T2DM患者，DD组和DS组血糖变化无明显差异。在ND组有3名患者术中血糖高于控制范围，接受胰岛素治疗，并排除实验。其他各组患者术中血糖波动均未超出目标水平。结论：颅内动脉瘤患者静脉注射单次小剂量地塞米松明显升高术中血糖水平，且地塞米松的升血糖效应在非糖尿病患者中表现得更明显。非糖尿病患者术中亦有发生高糖血症的风险，因此麻醉医生应提高对非糖尿病患者术中血糖变化的警惕性。
[Abstract]:Objective: to observe the effect of single intravenous injection of dexamethasone on blood glucose and postoperative analgesia in patients with II type uropathy (T2DM) and non-diabetic patients during craniotomy, and to compare the changes of blood glucose between the two groups of patients. To explore the necessity of blood glucose monitoring in these patients. Methods: 60 patients with ASA I or II grade were selected for selective intracranial aneurysm clipping. 30 patients with type I or II grade II diabetes and 30 non-diabetic patients with age 18-60 years old were enrolled in this study. Patients with no important organ dysfunction, such as heart, liver and kidney dysfunction, no anemia HB < 11g dL-1;, no history of long-term use of glucocorticoid drugs, contraindication of test drugs, no addiction to or dependence on sedative or analgesic drugs; Diabetic patients met the diagnostic criteria for type II diabetes. Patients with T2DM were randomly divided into dexamethasone group (DD group) and normal saline group (DS group), and non-diabetic patients were randomly divided into dexamethasone group (ND group), normal saline group (NS group), DD group and ND group. Dexamethasone 10mg (2ml) DS group and NS group were injected intravenously with 30min before anesthesia induction, and 2 ml of normal saline were injected intravenously with 30min before anesthesia induction. The blood glucose of the left radial artery was collected from the left radial artery for blood glucose analysis in each group before and 60 minutes after administration, and the average increase of blood glucose in each group was calculated, expressed by the difference between the maximum blood glucose value and the base value. The objective of blood glucose control in T2DM was 5.0-11.0mmol L 1, while that in non diabetic patients was 3.9-8.3mmol L 1. If blood sugar is below the target limit, 5% glucose solution is injected to correct, and insulin treatment is given above the target limit. Results: the intraoperative blood glucose levels in Dexamethasone 120 min DD group and ND group were significantly higher than those before operation (P0.05), and there was no significant difference between the blood glucose and the basic value at each time point after the administration of Dexamethasone at 240 min after treatment in DS group and NS group. Blood glucose in ND group was significantly higher than that in NS group (P 0.05) at 120 min after administration, and was significantly increased in D D group (180 min) and DS group (P 0.05). The increase of blood glucose in ND group was significantly higher than that in NS group (P 0.05). There was no significant difference between DD group and DS group. In the ND group, 3 patients with intraoperative blood glucose were above the range of control, received insulin therapy, and excluded the experiment. The fluctuation of blood glucose in other groups did not exceed the target level. Conclusion: single small dose dexamethasone intravenously increased blood glucose level in intracranial aneurysm patients, and the effect of dexamethasone on blood glucose was more obvious in non-diabetic patients. Non-diabetic patients are at risk of hyperglycemia during operation, so anesthesiologists should be alert to the changes of blood glucose in non-diabetic patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R587.1;R651.1

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