妇科腹腔镜手术围术期血糖变化的研究

【摘要】 目的观察妇科腹腔镜手术围术期血糖的变化。方法 40例ASAⅠ级或Ⅱ级,全麻下择期行妇科腹腔镜手术患者,分别于入院时(T0)、麻醉前(T1)、诱导时(T2)、插管时(T3)、手术开始时(T4)、手术刺激最大时(T5)、术毕(T6)、拔管时(T7)及拔管后(T8)8个时点测量指尖血糖,并记录各时点MAP和HR。结果围术期各时点MAP和HR波动范围在基础值的20%以内,T1血糖较T0明显增高P<0.05,T6、T7、T8与T1比较,血糖明显增高,差异有统计学意义P<0.05,术前患者血糖均处于正常值(3.9～6.1mmol/L),T1较T0稍有升高,T2较T1稍有下降,随着手术进行,各时点血糖值有上升趋势,到T6时,血糖值高于正常高值(6.1mmol/L),并维持至T7、T8。结论妇科腹腔镜手术患者由于术前的焦虑情绪,导致血糖增高,术前予以适当镇静有助于减轻患者焦虑,术中维持适当的麻醉深度,有助于减轻手术创伤产生的应激反应,本研究采用全凭静脉麻醉,术中血糖仍有升高趋势,复合其他麻醉方式可能更有效减轻应激反应,术后镇痛对改善糖代谢有一定意义。更多还原

【Abstract】 Objective To observe perioperative change of blood glucose who has gynecologic laparoscopic surgery.Methods The method selects 40 ASA physical statusⅠ-Ⅱpatients undergoing selective gynecologic laparoscopic surgery under general anesthesia and records fingertip blood glucose,MAP and HR at different time point[on admission(T0),pre-anesthesia(T1),at induction of anesthesia(T2),tra-cheal intubation(T3),at the beginning of operation(T4),strong operative stimula-tion(T5),end of operation(T6),during extubation(T7),trachea extubation(T8)].Results The wave range of the MAP and HR in the time points of perioperative period is 20% of the basic value.Compare to T0,the value of the blood glucose in T1 is obviously increased(P<0.05).Compare to T1,the value of the blood glucose in T6,T7 and T8 are all obviously increased.The Blood Glucose Value of patients is normal(3.9-6.1mmol/l) before operation.During perioperative period the value of the blood glucose in T1 is higher than T0’s and T2.The value of the blood glucose is showed an increasing trend at different time point and the value of the blood glucose in T6,T7 and T8 is higher than normal.Conclusion The blood glucose of patient who has gynecologic laparoscopic surgery is increased for anxiety by operation and the patient would be quiet by giving sedatives before operation.Stress response of operation would be reduced by keeping proper depth of anesthesia during operation.In this study,the blood glucose value of patient is showed an increasing trend by taken total intravenous anesthesia.Composite various anesthesia methods may be used to reduced stress response and postoperative analgesia may be good to improve glucose metabolism.更多还原