胰高血糖素瘤外科手术治疗的麻醉处理附一例报道.docVIP

09年会-特殊病例报告 胰高血糖素瘤外科手术治疗的麻醉处理附一例报道 华中科技大学同济医学院附属同济医院麻醉学教研室，武汉 430030 桂伶俐mM，餐后最高21 mM。同时出现双下肢皮疹，渐累及下腹、腰背、头面部及手足。给予抗过敏及激素治疗皮疹可缓解，但停药后皮疹反复发作。全身皮疹交替，此起彼伏，迁延不愈，以四肢、下腹部及腰部为著。起病后，患者一般情况， mM。术前辅助检查，血常规HB 10g/L，血生化/L, ALB 34.7g/L，电解质正常入手术室BP 120/68 mmHg，HR 78次/分SpO2 99％,测手指血糖6.9 mM。面罩给氧后，以咪唑安定mg、芬太尼0.2mg、mg，丙泊酚100mg快诱导插管。神经元特异性烯醇化酶（NSE）、突触素（Syn）均（+） 　胰高血糖素瘤是一种罕见的胰腺内分泌肿瘤，肿瘤细胞可分泌过量的胰高血糖素，本病患病率为 0. 01 / 10 0 万 ～0. 1 / 100 万[ 1 ]。发病年龄多在45岁-60岁，60%患者为女性，60%-80%肿瘤为恶性，生长缓慢，但往往因诊断上的延误，发现为此病时已有转移，最常见转移部位是肝脏和淋巴结，此时平均生存2.5-3年[2]。 与胰岛素的作用相反，胰高血糖素是一种促进分解代谢的激素。胰高血糖素具有很强的促进糖原分解和糖异生作用，使血糖明显升高。胰高血糖素还可激活脂肪酶，促进脂肪分解，同时又能加强脂肪酸氧化，使酮体生成增多。药理剂量的胰高血糖素可使心肌细胞内cAMp 含量增加，心肌收缩增强。胰高血糖在血浆中的半衰期为min，主要在肝灭活，肾也有降解作用。腺瘤腺瘤cagonoma with and without syndrome: immunocytochemical study of 5 tumour cases and review of the literature. Virchows Arch A Pathol Anat, 1980, 388 ( 1 ): 51-67. Adams DR, Miller JJ, Seraphin KE. Glucagonoma syndrome. Journal of the American Academy of Dermatology, 2005, 53(4): 690-691. Nicoll JM, Catling SJ. Anaesthetic management of glucagonoma. Anaesthesia, 1985 40(2):152-157. McGavran MH, Unger RH, Recant L, et al. A glucagons secreting alpha cell cacinoma of the pancreas. N Engl J Med, 1966, 274(25): 1408-1413. Pattenden C, Dennison A. Miscellaneous conditions of the pancreas. Surgery (Oxford), 2007, 25(2): 95-97. Li Y, Zhu S, Yan M. Combined general/epidural anesthesia (ropivacaine 0.375%) versus general anesthesia for upper abdominal surgery. Anesth Analg, 2008, 106(5):1562-1565. and work. Many classes established the duty monitor system, let every students have class member services and for the class the opportunity to work, this is not a fixed position of the monitor system of rotation, which not only can let the monitor on duty in a days work for class service work, also can let students know more of the solution in the class, every student can learn. And the class cadre conference held regularly. Pay attention to class and major incidents in th