摘要
目的探讨肝切除术患者围术期高血糖发生的相关因素及乌司他丁对围术期血糖的影响。方法择期肝脏部分切除术患者70例，随机均分为两组，分别于麻醉开始时及手术开始时给予乌司他丁20万单位（U组）或等量生理盐水20ml（C组）。于手术切皮前（T1）、切肝前（T2）、切除病肝后20min（T3）、关闭腹腔后（T4）、术后第1天清晨（T5）和第2天清晨（T6）监测血糖。对年龄、手术切皮前空腹血糖值、术中出血量、手术时间、手术切除范围、是否进行术后镇痛、有无糖尿病病史与L时空腹血糖进行多元逐步回归分析。结果C组血糖在T1时最低，T2时逐步上升，T3～T5时达到高峰，T6时下降。U组血糖在T1时最低，T4时达高峰，T6时下降。T2～T6时C组血糖明显高于U组（P〈O．01）。T5时C组空腹血糖与术中出血量、手术切除范围、术前糖尿病史存在独立的正相关关系，回归方程R^2为0．827（P〈0．05）。结论肝切除术围术期高血糖的发生与术中出血量、手术切除范围、术前糖尿病史相关，乌司他丁对于这种高血糖反应具有显著改善作用。
Objective To explore the related factors of perfoperative hyperglycemia in patients undergoing hepatectomy and the effect of ulinastatin on perfoperative hlood glucose. Methods Seventy patients undergoing selective hepatectomy were chosen and randomly divided into the control group （group C） and the experimental group（group U）. The patients in group U were injected ulinastatin 200,000 units before anesthesia and be{ore surgery respectively. We measured the blood glucose at six time points including the time prior to skin incision （T1）, the time prior to hepatectomy （T2）, 20 minutes after liver lesion removed（T3）, the time right after closing the abdominal cavity（T4 ）, the next morning after surgery（T5）, and the second morning after surgery（T6 ）. The clinical data of group C： age, the value of fasting blood glucose （FBG） before skin cutting, the amount of intraoperative blood loss, the duration and the extent of surgery, the application of postoperative analgesia, and the history of diabetes with the FBG in the first postoperative morning were analyzed for multiple stepwise regression analysis. Results In group C, the FBG value increased gradually from its bottom in T1 and showed a downward trend in T8 after reached its peak in T3-T5. In group U, the FBG value increased gradually from its bottom in T1 and returned to preoperative level in T6 after reached its peak in T4. The FBG value was higher in group C compared with group U in all time points except T1. The FBG of the patient in group C in the first postoperative morning had independent correlativity among the intraoperative blood loss, the extent of surgical resection as well as the history of diabetes, and the 172 of regression equation was 0. 827 （P〈0.05）. Conclusion The hyperglycemia happened in the perfoperative period of hepatectomy had correlation with the amount of intraoperative blood toss, the extent of surgical resection and the history of diabetes. Additionally, ulinastatin can ameliorate this hyperglycemia.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第12期1167-1170,共4页
Journal of Clinical Anesthesiology
基金
天普研究基金资助项目(编号:01201036)
关键词
围术期
血糖
乌司他丁
肝切除术
Perfoperative period
Blood glucose
Ulinastatin
Hepatectomy
