Halter J B, Pflug A E
Metabolism. 1980 Nov;29(11 Suppl 1):1124-7. doi: 10.1016/0026-0495(80)90021-9.
Surgical stress with inhalation anesthesia is associated with increased circulating catecholamines, hyperglycemia, and impaired insulin secretion. These changes do not occur during surgical stress with spinal anesthesia, suggesting that they are neurally mediated due to pain initiated afferents from the site of tissue trauma. Inhalation anesthesia alone was found to suppress basal insulin levels and the insulin response to intravenous glucose with no significant increase in plasma norepinephrine and a decrease in plasma epinephrine. Thus, these changes in insulin secretion are not attributable to adrenergic mechanisms. In the postoperative period, however, suppressed insulin secretion was found to be correlated with elevated plasma epinephrine concentrations and may, therefore, be mediated by adrenergic mechanisms. Thus, these findings indicate that impaired insulin secretion during surgical stress may have two etiologies--one related to the type of anesthesia used and the other due to adrenomedullary stimulation due to pain.
吸入麻醉下的手术应激与循环儿茶酚胺增加、高血糖和胰岛素分泌受损有关。这些变化在脊髓麻醉下的手术应激期间不会发生，这表明它们是由组织创伤部位引发的疼痛传入神经介导的。单独吸入麻醉被发现会抑制基础胰岛素水平以及胰岛素对静脉注射葡萄糖的反应，血浆去甲肾上腺素无显著增加，血浆肾上腺素减少。因此，胰岛素分泌的这些变化并非归因于肾上腺素能机制。然而，在术后期间，发现胰岛素分泌受抑制与血浆肾上腺素浓度升高相关，因此可能由肾上腺素能机制介导。因此，这些发现表明手术应激期间胰岛素分泌受损可能有两个病因——一个与所用麻醉类型有关，另一个是由于疼痛引起的肾上腺髓质刺激。
