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右美托咪定对全麻非糖尿病患者葡萄糖相关激素和乳酸的影响:一项随机对照试验。

Effects of dexmedetomidine on glucose-related hormones and lactate in non-diabetic patients under general anesthesia: a randomized controlled trial.

机构信息

Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, China.

School of Medicine, Yangzhou University, Yangzhou, China.

出版信息

Minerva Anestesiol. 2022 Jan-Feb;88(1-2):8-15. doi: 10.23736/S0375-9393.21.15734-7. Epub 2021 Oct 28.

Abstract

BACKGROUND

The aim of this study was to explore the effects of dexmedetomidine on glucose-related hormones and lactate levels in non-diabetic patients undergoing malignant gastrointestinal tumor radical resection.

METHODS

Groups D1 and D2 received dexmedetomidine loading dose 1 µg/kg and maintenance dose 0.25 and 0.5 µg/kg/h, respectively. Group C received saline solution. Glucose, lactate, insulin, glucagon, cortisol, epinephrine, norepinephrine and dopamine levels were measured before dexmedetomidine infusion (T1), 1 h after surgery beginning (T2), at surgery ending (T3), and 1 h after transfer to the postanesthesia care unit (T4).

RESULTS

Compared with group C, glucose levels increased in group D2 at T2 and reduced in groups D1 and D2 at T4. Lactate levels reduced in groups D1 and D2 at T4. A positive correlation between glucose and lactate levels was found in all groups. Compared with group C, insulin level reduced in group D2 at T2; glucagon levels reduced in groups D1 and D2 at T4; cortisol levels reduced in group D1 at T4 and in group D2 at T3 and T4; epinephrine and norepinephrine levels reduced in group D1 at T4 and in group D2 at T2 and T4; and dopamine level reduced in group D2 at T4.

CONCLUSIONS

Dexmedetomidine loading dose 1 µg/kg and maintenance dose 0.25 µg/kg/h produces a stable insulin level and significant postoperative decreases in glucagon, cortisol, epinephrine and norepinephrine secretion with stable maintenance of intraoperative and postoperative blood glucose levels and decreased postoperative lactate levels in non-diabetic patients under general anesthesia.

摘要

背景

本研究旨在探讨右美托咪定对非糖尿病患者行胃肠恶性肿瘤根治术时血糖相关激素和乳酸水平的影响。

方法

D1组和 D2组分别给予右美托咪定负荷剂量 1 µg/kg 和维持剂量 0.25 和 0.5 µg/kg/h,C 组给予生理盐水。分别于右美托咪定输注前(T1)、手术开始后 1 小时(T2)、手术结束时(T3)和转至麻醉后恢复室 1 小时(T4)时测量血糖、乳酸、胰岛素、胰高血糖素、皮质醇、肾上腺素、去甲肾上腺素和多巴胺水平。

结果

与 C 组相比,D2组 T2时血糖升高,D1组和 D2组 T4时血糖降低。D1组和 D2组 T4时乳酸降低。各组血糖和乳酸水平呈正相关。与 C 组相比,D2组 T2时胰岛素降低;D1组和 D2组 T4时胰高血糖素降低;D1组 T4时皮质醇降低,D2组 T3和 T4时皮质醇降低;D1组 T4时肾上腺素和去甲肾上腺素降低,D2组 T2和 T4时肾上腺素和去甲肾上腺素降低;D2组 T4时多巴胺降低。

结论

右美托咪定负荷剂量 1 µg/kg 和维持剂量 0.25 µg/kg/h 可使非糖尿病患者全麻术中胰岛素水平稳定,术后胰高血糖素、皮质醇、肾上腺素和去甲肾上腺素分泌显著减少,术中及术后血糖水平稳定,术后乳酸水平降低。

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