【摘要】：目的：觀察術(shù)前單次靜脈注射小劑量地塞米松對(duì)II型尿病患者（T2DM）和非糖尿病患者在開顱手術(shù)中血糖的影響和術(shù)后鎮(zhèn)痛效果，比較兩類患者術(shù)中血糖變化情況，，探討此類患者術(shù)中行血糖監(jiān)測的必要性。 方法：擇期行顱內(nèi)動(dòng)脈瘤夾閉術(shù)的患者60例，ASA I或II級(jí)，年齡18-60歲，Hunt-Hess分級(jí)為I或II級(jí)。II型糖尿病患者30例，非糖尿病患者30例。術(shù)前檢查無重要臟器功能障礙者，如心、肝、腎功能不全者，無貧血，Hb＜11g·dL-1；無長期使用糖皮質(zhì)激素藥物史，試驗(yàn)藥物禁忌癥，對(duì)鎮(zhèn)靜或鎮(zhèn)痛藥物無成癮或依賴性；糖尿病患者符合II型糖尿病診斷標(biāo)準(zhǔn)。隨機(jī)將T2DM患者分成地塞米松組（DD組，n=15）和生理鹽水組（DS組，n=15），同樣將非糖尿病患者隨機(jī)分為地塞米松組（ND組，n=15）和生理鹽水組（NS組，n=15）。DD組和ND組，分別于麻醉誘導(dǎo)前30min靜脈注射地塞米松10mg（2ml），DS組和NS組，分別于麻醉誘導(dǎo)前30min靜脈注射生理鹽水2ml。各組分別于給藥前，給藥后60min、120min、180min、240min采左側(cè)橈動(dòng)脈血進(jìn)行血糖分析，并計(jì)算各組患者平均血糖升高幅度，用最大血糖值與基礎(chǔ)值的差值表示。維持患者術(shù)中循環(huán)的穩(wěn)定，T2DM術(shù)中血糖控制目標(biāo)為5.0-11.0mmol·L-1，非糖尿病患者控制術(shù)中血糖3.9-8.3mmol·L-1。如血糖低于目標(biāo)下限，輸注5%的葡萄糖液糾正；血糖高于目標(biāo)上限，給予胰島素治療。 結(jié)果：組內(nèi)比較，給予地塞米松120min，DD組和ND組術(shù)中血糖較術(shù)前均明顯升高（P0.05），且持續(xù)至用藥后240min；DS組和NS組，各時(shí)間點(diǎn)血糖與基礎(chǔ)值之間差異無統(tǒng)計(jì)學(xué)意義。組間比較，在給藥后120min，ND組血糖明顯高于NS組（P 0.05），至給藥后240min；給藥后180min、240min,DD組與DS組比較，血糖顯著升高（P 0.05）。非糖尿病患者，ND組血糖升高幅度明顯高于NS組（P 0.05）。T2DM患者，DD組和DS組血糖變化無明顯差異。在ND組有3名患者術(shù)中血糖高于控制范圍，接受胰島素治療，并排除實(shí)驗(yàn)。其他各組患者術(shù)中血糖波動(dòng)均未超出目標(biāo)水平。 結(jié)論：顱內(nèi)動(dòng)脈瘤患者靜脈注射單次小劑量地塞米松明顯升高術(shù)中血糖水平，且地塞米松的升血糖效應(yīng)在非糖尿病患者中表現(xiàn)得更明顯。非糖尿病患者術(shù)中亦有發(fā)生高糖血癥的風(fēng)險(xiǎn)，因此麻醉醫(yī)生應(yīng)提高對(duì)非糖尿病患者術(shù)中血糖變化的警惕性。
[Abstract]:Objective: to observe the effect of single intravenous injection of dexamethasone on blood glucose and postoperative analgesia in patients with II type uropathy (T2DM) and non-diabetic patients during craniotomy, and to compare the changes of blood glucose between the two groups of patients. To explore the necessity of blood glucose monitoring in these patients. Methods: 60 patients with ASA I or II grade were selected for selective intracranial aneurysm clipping. 30 patients with type I or II grade II diabetes and 30 non-diabetic patients with age 18-60 years old were enrolled in this study. Patients with no important organ dysfunction, such as heart, liver and kidney dysfunction, no anemia HB < 11g dL-1;, no history of long-term use of glucocorticoid drugs, contraindication of test drugs, no addiction to or dependence on sedative or analgesic drugs; Diabetic patients met the diagnostic criteria for type II diabetes. Patients with T2DM were randomly divided into dexamethasone group (DD group) and normal saline group (DS group), and non-diabetic patients were randomly divided into dexamethasone group (ND group), normal saline group (NS group), DD group and ND group. Dexamethasone 10mg (2ml) DS group and NS group were injected intravenously with 30min before anesthesia induction, and 2 ml of normal saline were injected intravenously with 30min before anesthesia induction. The blood glucose of the left radial artery was collected from the left radial artery for blood glucose analysis in each group before and 60 minutes after administration, and the average increase of blood glucose in each group was calculated, expressed by the difference between the maximum blood glucose value and the base value. The objective of blood glucose control in T2DM was 5.0-11.0mmol L 1, while that in non diabetic patients was 3.9-8.3mmol L 1. If blood sugar is below the target limit, 5% glucose solution is injected to correct, and insulin treatment is given above the target limit. Results: the intraoperative blood glucose levels in Dexamethasone 120 min DD group and ND group were significantly higher than those before operation (P0.05), and there was no significant difference between the blood glucose and the basic value at each time point after the administration of Dexamethasone at 240 min after treatment in DS group and NS group. Blood glucose in ND group was significantly higher than that in NS group (P 0.05) at 120 min after administration, and was significantly increased in D D group (180 min) and DS group (P 0.05). The increase of blood glucose in ND group was significantly higher than that in NS group (P 0.05). There was no significant difference between DD group and DS group. In the ND group, 3 patients with intraoperative blood glucose were above the range of control, received insulin therapy, and excluded the experiment. The fluctuation of blood glucose in other groups did not exceed the target level. Conclusion: single small dose dexamethasone intravenously increased blood glucose level in intracranial aneurysm patients, and the effect of dexamethasone on blood glucose was more obvious in non-diabetic patients. Non-diabetic patients are at risk of hyperglycemia during operation, so anesthesiologists should be alert to the changes of blood glucose in non-diabetic patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R587.1;R651.1

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