长时间七氟醚麻醉期间的葡萄糖不耐受

Glucose intolerance during prolonged sevoflurane anaesthesia.

作者信息

Iwasaka H, Itoh K, Miyakawa H, Kitano T, Taniguchi K, Honda N

机构信息

Department of Anaesthesiology, Oita Medical University, Japan.

出版信息

Can J Anaesth. 1996 Oct;43(10):1059-61. doi: 10.1007/BF03011909.

DOI:10.1007/BF03011909

PMID:8896859

Abstract

PURPOSE

The effects of prolonged sevoflurane anaesthesia on insulin sensitivity were investigated by two successive intravenous glucose tolerance tests (IVGTT) in eight patients who underwent prolonged surgery.

METHODS

The first IVGTT was administered (25 g glucose as 20% dextrose in water iv) over two minutes 35 min after initiation of surgery. Arterial blood samples were obtained at 0, 5, 10, 30, 60, and 120 min after glucose administration for blood glucose and plasma insulin determination. A second IVGTT was performed six hours following the initiation of surgery.

RESULTS

The disappearance rate of glucose (k-value) for the first IVGTT was 0.887 +/- 0.436 (mean +/- SD) %.min-1, and 0.784 +/- 0.289 for the second IVGTT. Both k-values are lower than the normal value. The maximum insulin response to glucose (delta IRI-delta BS-1) of the second IVGTT was lower than the first IVGTT (0.124 +/- 0.092 vs 0.071 +/- 0.056, P < 0.05). The total insulin output of the first IVGTT was higher than the second IVGTT (1.161 +/- 830 vs 568 +/- 389 microU.min.ml-1, P < 0.05).

CONCLUSION

Glucose intolerance is enhanced by diminished insulin output in response to blood glucose elevation during prolonged anaesthesia and surgery.

摘要

目的

通过对八名接受长时间手术的患者进行两次连续的静脉葡萄糖耐量试验（IVGTT），研究长时间七氟醚麻醉对胰岛素敏感性的影响。

方法

在手术开始后35分钟，两分钟内静脉注射（25克葡萄糖，以20%葡萄糖水溶液形式）进行第一次IVGTT。在给予葡萄糖后的0、5、10、30、60和120分钟采集动脉血样本，用于测定血糖和血浆胰岛素。在手术开始后六小时进行第二次IVGTT。

结果

第一次IVGTT的葡萄糖消失率（k值）为0.887±0.436（平均值±标准差）%·分钟⁻¹，第二次IVGTT为0.784±0.289。两个k值均低于正常值。第二次IVGTT对葡萄糖的最大胰岛素反应（δIRI-δBS⁻¹）低于第一次IVGTT（0.124±0.092对0.071±0.056，P<0.05）。第一次IVGTT的总胰岛素分泌量高于第二次IVGTT（1.161±830对568±389微单位·分钟·毫升⁻¹，P<0.05）。