对比探究糖尿病患者行全身麻醉与硬膜外麻醉对其围手术期血糖的影响

王建越 李红磊

[摘要] 目的 對比糖尿病患者行全身麻醉与硬膜外麻醉对其围手术期血糖的影响。方法 从该院收治的糖尿病患者中抽取80例作为研究对象，按入院时间将其分为两组，2018年3—9月的40例患者纳为对照组，采用全身麻醉;2018年10月—2019年4月的40例患者则为研究组，采用硬膜外麻醉。对比两组患者的血糖水平、胰岛素使用剂量、心率、舒张压、收缩压情况。结果 手术前，两组患者的血糖水平差异无统计学意义（P>0.05）;手术后，研究组患者手术结束时、手术后2 h、手术后24 h的血糖水平均低于对照组，差异有统计意义（P<0.05）。研究组患者手术结束时、手术后2 h的心率、舒张压、收缩压优于对照组，且胰岛素使用剂量少于对照组，差异有统计学意义（P<0.05）。 结论 对糖尿病患者手术期间进行硬膜外麻醉方法能有效控制其血糖值，减少手术中胰岛素的使用量，患者的身体体征更趋于平稳。

[关键词] 糖尿病;全身麻醉;硬膜外麻醉;围手术期血糖

[中图分类号] R587.1;R614          [文献标识码] A          [文章编号] 1672-4062（2020）05（b）-0021-03

Comparative Study of the Effects of General Anesthesia and Epidural Anesthesia on Perioperative Blood Glucose in Patients with Diabetes

WANG Jian-yue， LI Hong-lei

Department of Anesthesiology， Binzhou People's Hospital， Binzhou， Shandong Province， 256601 China

[Abstract] Objective To compare the effects of general anesthesia and epidural anesthesia on blood glucose in patients with diabetes during perioperative period. Methods Eighty cases of diabetic patients admitted in the hospital were selected as the research object， and they were divided into two groups according to the time of admission. Forty patients from March to September 2018 were included as the control group and under general anesthesia; 40 patients from October 2018 to April 2019 were in the study group and were treated with epidural anesthesia. The blood glucose level， insulin dosage， heart rate， diastolic blood pressure， and systolic blood pressure of the two groups of patients were compared. Results There was no statistical difference in blood glucose levels between the two groups of patients before surgery （P>0.05）. After surgery， the blood glucose levels of patients in the study group at the end of surgery， 2 h after surgery， and 24 h after surgery were lower than those in the control group（P<0.05）. The heart rate， diastolic blood pressure， and systolic blood pressure of the study group were better than those of the control group at the end of the operation and 2 h after the operation， and the dose of insulin was less than that of the control group， and the differences were statistically significant （P<0.05）. Conclusion The epidural anesthesia method can effectively control the blood glucose of diabetic patients during surgery， reduce the amount of insulin used during surgery， and the patient's physical signs become more stable.

[Key words] Diabetes; General anesthesia; Epidural anesthesia; Perioperative blood glucose

糖尿病是一种以高血糖为特点的自身代谢异常的疾病，由于患者脏器代谢能力极低，围手术期所使用的麻醉药物无法快速代谢出去，进而导致患者的血流动力学产生较大的波动，同时对患者的神经细胞产生一定的损害，若药量、麻醉时间控制不当，还会诱发一系列严重的并发症，给患者生命健康带来威胁。糖尿病患者由于系统代谢功能异常，在其围手术期间的血糖水平和感染概率也容易升高，且病死率比普通患者高出5倍，导致手术风险极大，对患者后期的恢复带来不利影响[1]。临床上有研究表明，糖尿病患者的手术刀口愈合缓慢是由于其体内血糖过高，同时机体代谢出现阻碍，抑制了蛋白质合成而导致的现象[2]。因此，需考虑在手术中如何控制患者的血糖、血流动力学指标波动较大，如选择合理的麻醉方式等[3]。临床……