本文關(guān)鍵詞： 七氟烷 丙泊酚 瑞芬太尼 血糖 胰島素敏感性　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:觀察七氟烷或丙泊酚復(fù)合瑞芬太尼對全麻患者血糖和胰島素敏感性的影響。方法:擇期在全麻下行腰椎手術(shù)的患者40例,ASAⅠ~Ⅱ級,性別不限,年齡18~60歲,體重指數(shù)18~25kg/m2,隨機(jī)分為兩組:七氟烷復(fù)合瑞芬太尼組(SR組,n=20)和丙泊酚復(fù)合瑞芬太尼組(PR組,n=20)。SR組靜脈注射咪達(dá)唑侖0.05mg/kg,舒芬太尼0.3~0.4ug/kg,苯磺順阿曲庫銨0.2mg/kg并通過面罩吸入6%七氟烷行麻醉誘導(dǎo),PR組靜脈注射丙泊酚1.5mg/kg代替七氟烷吸入,余用藥同SR組行麻醉誘導(dǎo)。術(shù)中SR組吸入1.5%~2.5%七氟烷復(fù)合瑞芬太尼0.25~0.5μg·kg-1·min-1持續(xù)靜脈泵注維持麻醉,PR組持續(xù)靜脈泵注丙泊酚4~12mg·kg-1·h-1復(fù)合瑞芬太尼0.25~0.5μg·kg-1·min-1維持麻醉。術(shù)中控制BIS值在40~60,測定兩組患者麻醉前(T_0)、氣管插管后5min(T_1)、術(shù)中1h(T_2)、術(shù)中2h(T_3)、拔出氣管導(dǎo)管后15min(T_4)肘靜脈血中葡萄糖(Glu)、C肽、胰島素(Ins)、皮質(zhì)醇(Cor)濃度,用公式計(jì)算胰島素敏感指數(shù)(ISI)和抵抗指數(shù)(IRI),并記錄兩組患者五個(gè)時(shí)間點(diǎn)的HR、MAP、BIS值、腋窩溫度的變化以及血糖異常(偏離正常值)的發(fā)生例數(shù)。結(jié)果:(1)兩組患者一般資料比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);(2)兩組患者同一時(shí)間點(diǎn)的HR、MAP、BIS值和腋窩溫度比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);與T_0時(shí)間點(diǎn)比較,兩組患者在T_1、T_2、T_3時(shí)間點(diǎn)的HR、MAP、BIS值均下降(P0.05);T_4時(shí)間點(diǎn)上升接近于T_0水平(P0.05);(3)兩組患者在T_0、T_1時(shí)間點(diǎn)的Glu、Ins和C肽比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),在T_2、T_3、T_4時(shí)間點(diǎn),PR組的Glu低于SR組(P0.05),Ins和C肽高于SR組(P0.05);同一時(shí)間點(diǎn)兩組患者的Cor、ISI和IRI比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。組內(nèi)比較,SR組患者在T_1間點(diǎn)的Glu、Cor較T_0時(shí)間點(diǎn)降低(P0.05),在T_2、T_3、T_4時(shí)間點(diǎn),Glu、Ins、C肽、ISI和IRI與T_0時(shí)間點(diǎn)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);PR組在T_1、T_2、T_3、T_4時(shí)間點(diǎn)的Glu、Cor均較T_0時(shí)間點(diǎn)低(P0.05),在T_1時(shí)間點(diǎn)的Ins和C肽與T_0時(shí)間點(diǎn)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),但在T_2、T_3、T_4時(shí)間點(diǎn)的Ins和C肽較T_0和T_1時(shí)間點(diǎn)升高(P0.05);ISI和IRI與T_0時(shí)間點(diǎn)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);(4)兩組患者血糖異常的發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:七氟烷或丙泊酚復(fù)合瑞芬太尼全麻均不影響胰島素敏感性,但丙泊酚復(fù)合瑞芬太尼全麻有促進(jìn)胰島素分泌趨勢,使術(shù)中和蘇醒期的血糖相對較低。
[Abstract]:Objective: to observe the effect of sevoflurane or propofol combined with remifentanil on blood glucose and insulin sensitivity in patients with general anesthesia. Age 1860, BMI 1825 kg / m2, were randomly divided into two groups: sevoflurane combined with remifentanil group (n = 20) and propofol combined with remifentanil group (n = 20) or propofol combined with remifentanil group (n = 20). Midazolam was injected intravenously with midazolam 0.05 mg / kg and sufentanil 0.3g / kg per kg in SR group. Benzenesulfonate cis-atracurium 0.2mg / kg and 6% sevoflurane were inhaled through the mask. Propofol 1.5 mg / kg was injected intravenously in group PR instead of sevoflurane. Anesthetic induction was performed in SR group. Anesthesia was maintained by continuous intravenous infusion of 1.5% sevoflurane combined with remifentanil 0.25 渭 g 路kg-1 路min-1 during the operation in SR group. In PR group, intravenous infusion of propofol 4mg 路kg-1 路h-1 and remifentanil 0.250.5 渭 g 路kg-1 路min-1 was used to maintain anesthesia. BIS was controlled at 40 渭 g 路h -1 during operation. Con 60. The patients in both groups were measured before anesthesia, 5 min after tracheal intubation, 1 hour after operation, 1 hour after operation, 2 hours after operation, and 2 hours after operation. The concentration of Glu-C peptide, insulin Insna and cortisol in the blood of elbow vein was 15 min after trachea catheter was pulled out. The insulin sensitivity index (ISI) and the resistance index (IRI) were calculated by the formula, and the BIS values of HRG MAPV were recorded at five time points in the two groups. The change of axillary temperature and the occurrence of abnormal blood glucose (deviate from normal value). Results there was no significant difference in general data between the two groups (P 0.05). (2) there was no significant difference between the BIS value of HRP MAPV and the axillary temperature in the two groups at the same time point (P 0.05). Compared with T0 time point, the BIS values of HRP MAPV in T1 / T _ 2 / T _ 2 / T _ 3 were decreased in both groups (P < 0.05) at the time point of T _ 1 / T _ 2 / T _ 2 / T _ 2 / T _ 2 / T _ 3. The increase of T4 time point was close to that of T _ 0 level (P _ 0.05); (3) there was no significant difference in Gluin ins and C peptide between the two groups at the time point of T _ 2 / T _ 1, but there was no significant difference between the two groups at the time point of T _ 2 / T _ T _ 3 / T _ 4. The Glu of PR group was lower than that of SR group (P 0.05) and C peptide was higher than that of SR group (P 0.05). There was no significant difference in Cortex ISI and IRI between the two groups at the same time point. The Glu of SR group was compared with that of SR group at T 1 point. Cor was lower than T _ 0 in time point (P _ 0.05) and compared with T _ 0 at T _ S _ 2T _ 3 / T _ T _ 4 / T _ S _ I _ I _ I _ I _ I _ I _ I _ I _ I _ I to T _ T _ 0 time point. The difference was not statistically significant (P 0.05). The Glu-Cor of PR group at T _ 1 / T _ 2 / T _ 3 / T _ S _ 4 time point was lower than that of T _ 0 / T _ (0) (P < 0.05). There was no significant difference between the Ins and C peptide at T _ 1 and T _ 0, but there was no significant difference in T _ (2) / T _ (3) between T _ (1) and T _ (0). The levels of Ins and C-peptide at T _ 4 time point were higher than those at T _ (0) and T _ S _ (1) time points (P = 0.05). There was no significant difference between ISI and IRI in time points compared with that in T _ (0) group (P 0.05). Conclusion: sevoflurane or propofol combined with remifentanil has no effect on insulin sensitivity. However, propofol combined with remifentanil has a tendency to promote insulin secretion and lower blood glucose during operation and recovery.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614.2

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