Sener M, Caliskan E, Bozdogan N, Kocum A, Oner S O, Atalay H, Kayhan Z
Department of Anesthesiology and Reanimation, Baskent University Faculty of Medicine, Ankara, Turkiye.
Exp Clin Endocrinol Diabetes. 2010 Mar;118(3):190-4. doi: 10.1055/s-0029-1237381. Epub 2009 Oct 15.
We investigated the effect of thoracic epidural anesthesia on perioperative blood glucose levels in diabetic patients undergoing cardiopulmonary bypass by continuous insulin infusion according to the Portland Protocol.
Diabetic patients undergoing surgery with cardiopulmonary bypass were assigned to receive either general anesthesia alone (n=40) or general anesthesia with thoracic epidural anesthesia (n=18). Patient data were retrospectively reviewed from prospective chart records used in our anesthesia clinic. In all study patients, insulin infusion with the Portland Protocol was used to maintain stable blood glucose levels. We evaluated blood glucose levels in both groups at 6 time points including before surgery, before cardiopulmonary bypass, during cardiopulmonary bypass, immediately following cardiopulmonary bypass, and on the first and second postoperative days. The amounts of insulin required at the intraoperative period and during two postoperative days were compared between two groups.
Groups were similar with respect to the duration of cardiopulmonary bypass, aortic cross-clamping, surgery, and blood glucose levels at any of the 6 time points, mean insulin requirements during intraoperative period and mean insulin requirements and blood glucose levels during the first 2 postoperative days (General anesthesia alone, 189+/-29 mg/dl vs. General anesthesia with thoracic epidural anesthesia, 191+/-19 mg/dl; p=0.782).
In diabetic patients undergoing cardiopulmonary bypass receiving insulin infusion by the Portland Protocol for glycemic control, thoracic epidural anesthesia provides no additional benefit for maintaining blood glucose levels during surgery.
我们根据波特兰方案通过持续输注胰岛素，研究了胸段硬膜外麻醉对接受体外循环的糖尿病患者围手术期血糖水平的影响。
将接受体外循环手术的糖尿病患者分为两组，一组仅接受全身麻醉（n = 40），另一组接受全身麻醉联合胸段硬膜外麻醉（n = 18）。我们从麻醉门诊使用的前瞻性病历记录中回顾性地分析患者数据。在所有研究患者中，均采用波特兰方案输注胰岛素以维持稳定的血糖水平。我们在6个时间点评估了两组患者的血糖水平，包括手术前、体外循环前、体外循环期间、体外循环结束后即刻以及术后第1天和第2天。比较了两组患者术中及术后两天所需胰岛素的用量。
两组在体外循环时间、主动脉阻断时间、手术时间以及6个时间点中任何一个时间点的血糖水平、术中平均胰岛素需求量以及术后前两天的平均胰岛素需求量和血糖水平方面均相似（仅全身麻醉组，189±29mg/dl；全身麻醉联合胸段硬膜外麻醉组，191±19mg/dl；p = 0.782）。
对于接受体外循环并通过波特兰方案输注胰岛素进行血糖控制的糖尿病患者，胸段硬膜外麻醉在手术期间维持血糖水平方面并无额外益处。
