Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2013 Feb;57(2):171-7. doi: 10.1111/j.1399-6576.2012.02731.x. Epub 2012 Jul 4.
Assuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery.
Forty-two low-risk patients age 65-79 years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia. BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3 h together with administration of insulin. Postoperative pain was evaluated 30 min, 2, 4 and 6 h after extubation, and before discharge from the intensive care unit.
Overall BG levels showed great variation over time (P < 0.001). No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P = 0.042). The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P < 0.001).
HTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.
假设高位胸段硬膜外镇痛（HTEA）合并交感神经阻滞可能降低术后血糖（BG）水平并减少胰岛素的需求，本研究旨在评估 HTEA 对行心脏手术患者 BG 水平和胰岛素需求的影响。
42 例年龄 65-79 岁、拟行择期冠状动脉旁路移植术（CABG）联合或不联合主动脉瓣置换术的低危患者，随机分为接受 HTEA 作为全身麻醉补充的 HTEA 组。在体外循环前后以及术后至少每 3 小时测量 BG 和乳酸水平，并同时给予胰岛素。术后拔管后 30 分钟、2、4 和 6 小时以及从重症监护病房出院前评估术后疼痛。
总体 BG 水平随时间变化差异很大（P < 0.001）。围手术期 BG 无统计学差异，但 HTEA 组术后 BG 水平较低（P = 0.042）。术后不接受胰岛素治疗的患者在 HTEA 组明显更多（9 例比 2 例，P = 0.032）。乳酸水平无差异。HTEA 组患者的疼痛评分显著较低（P < 0.001）。
HTEA 可更好地维持葡萄糖代谢，使心脏手术患者的“应激性高血糖”程度降低。
