Stein T A, Vaughan R W, Wise L
Surg Gynecol Obstet. 1979 Mar;148(3):380-4.
Intraoperative glucose metabolism was studied in seven grossly obese patients during an intestinal bypass surgical procedure. Preoperative fasting plasma glucose levels were in the low normal range. Results of intravenous glucose tolerance studies during the preoperative period suggested that three patients demonstrated a diabetic utilization of glucose. Fasting awake plasma glucose levels were increased after premedication for anesthesia and surgical treatment. Following induction of anesthesia, laryngoscopy and intubation, there was a further increase in glucose concentrations. In five patients, a 25 gram glucose load was given intravenously during the anesthetic period and prior to operation; glucose utilization was severely impaired in all patients. When the glucose load was not administered to two patients, a slow uptake of glucose was suggested. Surgical trauma did not further decrease glucose utilization after anesthesia. In patients with no glucose load, surgical treatment resulted in a gradual rise in glucose levels. These results suggested that intraoperative glucose utilization is impaired in the obese. Although a marked osmotic diuresis leading to hypovolemia is not apparent in the present study, decreased intraoperative glucose utilization demonstrates that cautious intraoperative administration of glucose should be considered in the obese patient.
对7例极度肥胖患者在肠道分流手术过程中的术中葡萄糖代谢情况进行了研究。术前空腹血浆葡萄糖水平处于低正常范围。术前静脉葡萄糖耐量研究结果表明，3例患者表现出糖尿病患者的葡萄糖利用情况。麻醉和手术治疗的术前用药后，清醒时的空腹血浆葡萄糖水平升高。麻醉诱导、喉镜检查和插管后，葡萄糖浓度进一步升高。5例患者在麻醉期间且手术前静脉给予25克葡萄糖负荷；所有患者的葡萄糖利用均严重受损。当未对2例患者给予葡萄糖负荷时，提示葡萄糖摄取缓慢。麻醉后手术创伤并未进一步降低葡萄糖利用。在未给予葡萄糖负荷的患者中，手术治疗导致葡萄糖水平逐渐升高。这些结果表明，肥胖患者术中葡萄糖利用受损。尽管在本研究中未明显出现导致血容量不足的显著渗透性利尿，但术中葡萄糖利用降低表明，肥胖患者术中应谨慎给予葡萄糖。
