嗜铬细胞瘤患者使用人工内分泌胰腺进行血糖控制。

Blood glucose control by an artificial endocrine pancreas in a patient with phaeochromocytoma.

作者信息

Hamaji M, Miyata M, Kawamori R, Shichiri M, Mashimo T, Nakao K, Kawashima Y

出版信息

Can Anaesth Soc J. 1985 Sep;32(5):538-42. doi: 10.1007/BF03010805.

PMID:4041955

Abstract

In a patient with phaeochromocytoma who presented with unstable diabetes mellitus, an artificial endocrine pancreas was used intraoperatively. Anaesthetic agents included enflurane, nitrous oxide and oxygen. Nicardipine was used to control hypertensive episodes. The initial blood glucose concentration was 173 mg X dl-1 and it decreased to 110 mg X dl-1 in response to insulin infusion, but plasma catecholamines were markedly increased. Seventy minutes later, the glucose concentration increased progressively to 249 mg X dl-1 despite massive insulin infusion, maximally 5.64 mU X kg-1 X min-1. The blood glucose concentration reached a peak at the time of the ligation of the venous drainage from the tumour and the peak was coincident with that of plasma catecholamine levels (epinephrine: 20.8 ng X ml-1, norepinephrine 16.4 ng X ml-1). Both glucose and catecholamine concentrations decreased promptly after removal of the tumour and hypotension followed likely because of a persistent vasodilatatory effect of nicardipine. The profiles of blood glucose, insulin and glucose infusion rates provided by the artificial endocrine pancreas suggested that the insulin resistance began to be reversed shortly after removal of the phaeochromocytoma.

摘要

在一名患有嗜铬细胞瘤且伴有不稳定型糖尿病的患者中，术中使用了人工内分泌胰腺。麻醉剂包括恩氟烷、氧化亚氮和氧气。尼卡地平用于控制高血压发作。初始血糖浓度为173mg×dl⁻¹，胰岛素输注后降至110mg×dl⁻¹，但血浆儿茶酚胺明显升高。70分钟后，尽管大量输注胰岛素（最大剂量为5.64mU×kg⁻¹×min⁻¹），血糖浓度仍逐渐升至249mg×dl⁻¹。血糖浓度在肿瘤静脉引流结扎时达到峰值，且该峰值与血浆儿茶酚胺水平（肾上腺素：20.8ng×ml⁻¹，去甲肾上腺素16.4ng×ml⁻¹）的峰值一致。切除肿瘤后，血糖和儿茶酚胺浓度迅速下降，随后可能由于尼卡地平持续的血管舒张作用而出现低血压。人工内分泌胰腺提供的血糖、胰岛素和葡萄糖输注速率曲线表明，切除嗜铬细胞瘤后不久胰岛素抵抗开始得到逆转。