Burgos L G, Ebert T J, Asiddao C, Turner L A, Pattison C Z, Wang-Cheng R, Kampine J P
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee 53226.
Anesthesiology. 1989 Apr;70(4):591-7. doi: 10.1097/00000542-198904000-00006.
Thirty-eight consenting subjects scheduled for elective ophthalmologic surgery were classified as nondiabetics (n = 21) or diabetics (n = 17) and were tested preoperatively for autonomic dysfunction. The autonomic tests consisted of respiratory sinus arrhythmia and heart rate responses to the Valsalva maneuver to test cardiac vagal function and diastolic blood pressure responses to head-up tilt and cold pressor test to assess sympathetic efferent integrity. At a separate time, anesthesia was established with fentanyl (2 micrograms/kg), sodium thiopental (3-5 mg/kg), and vecuronium (0.1 mg/kg), and maintained with isoflurane, oxygen, and nitrous oxide. An anesthesiologist, blinded to the autonomic test results, recorded perioperative blood pressure and heart rate. The autonomic test results revealed significant autonomic dysfunction among the diabetics. Heart rate and blood pressure declined to a greater degree (P less than 0.05) during induction of anesthesia in diabetics compared with controls and there was less of an increase in these same parameters following tracheal intubation in diabetic patients. Thirty-five percent of diabetics required intraoperative vasopressors compared with only 5% of control patients (P less than 0.05). A major finding was that the diabetics who required intraoperative blood pressure support had significantly greater impairment of autonomic test results compared with those diabetics who did not need vasopressors. Diabetics are at increased risk for cardiovascular lability during anesthesia and preoperative screening of diabetics with simple noninvasive autonomic tests may be useful in identifying those at high risk for perioperative cardiovascular instability.
38名计划接受择期眼科手术的受试者被分为非糖尿病患者（n = 21）或糖尿病患者（n = 17），并在术前进行自主神经功能障碍测试。自主神经测试包括呼吸性窦性心律失常以及对瓦尔萨尔瓦动作的心率反应，以测试心脏迷走神经功能，还有对抬头倾斜和冷加压试验的舒张压反应，以评估交感神经传出完整性。在另一个时间点，使用芬太尼（2微克/千克）、硫喷妥钠（3 - 5毫克/千克）和维库溴铵（0.1毫克/千克）建立麻醉，并使用异氟醚、氧气和一氧化二氮维持麻醉。一名对自主神经测试结果不知情的麻醉医生记录围手术期的血压和心率。自主神经测试结果显示糖尿病患者中存在明显的自主神经功能障碍。与对照组相比，糖尿病患者在麻醉诱导期间心率和血压下降幅度更大（P < 0.05），并且糖尿病患者气管插管后这些参数的增加幅度较小。35%的糖尿病患者术中需要血管加压药，而对照组患者仅为5%（P < 0.05）。一个主要发现是，与那些不需要血管加压药的糖尿病患者相比，术中需要血压支持的糖尿病患者自主神经测试结果的受损程度明显更大。糖尿病患者在麻醉期间发生心血管不稳定的风险增加，术前用简单的非侵入性自主神经测试对糖尿病患者进行筛查可能有助于识别那些围手术期心血管不稳定高危患者。
