右美托咪定对2型糖尿病患者围术期血糖血浆皮质醇和肾上腺素影响.docVIP

右美托咪定对2型糖尿病患者围术期血糖血浆皮质醇和肾上腺素影响 　　 作者单位：454000 河南省焦作市第四人民医院（赵惠君）；上海市第六人民医院（李静，王爱忠） 　　通讯作者：王爱忠 　　【摘要】 目的 观察右美托咪定对2型糖尿病患者围术期血糖、血浆皮质醇和肾上腺素的影响。方法 40例合并2型糖尿病且择期行全髋置换术的患者，随机分为盐酸右美托咪定组（D组，n22）和对照组（C组,n＝18），两组患者均采用相同的麻醉诱导及维持方法。D组的患者从麻醉诱导开始，15 min内静脉泵入剂量为1 μg/kg的盐酸右美托咪定，随后以0.5 μg/（kg?h）维持至手术结束；C组输入相同容量的生理盐水。两组患者均于麻醉诱导前（T0）、手术开始1 h（T1）、拔管即刻（T2）、术后1 d（T3）和术后2 d（T4）晨采取静脉血，测定血糖、血浆皮质醇和肾上腺素浓度。结果 D组患者的血糖、血浆皮质醇和肾上腺素浓度显著低于C组对应时点的值（P＜0.05,或 P＜0.01）。结论 盐酸右美托咪定能显著降低2型糖尿病患者的围术期应激反应，有利于这类患者围手术期的血糖稳定。 　　【关键词】 右美托咪定； 2型糖尿病； 血糖； 皮质醇； 肾上腺素 　　Effects of dexmedetomidine on blood glucose,serum cortisol and epinephrine in type two diabetic patients during perioperation ZHAO Hui-jun, LI Jing, WANG Ai-zhong. Jiaozuo Fourth Peoples Hospital, Jiaozuo City 454000, China 　　【Abstract】 Objective To determine the effects of dexmedetomidine on blood glucose, serum cortisol and epinephrine in type two diabetic patients during perioperation.Methods Forty patients with type two diabetes and undergoing hip replacement surgery were randomly divided into dexmedetomidine group （group D,n22） and control group（group C,n＝18）. Anesthesia induction and maintenance were same in two groups. In group D, 1 μg/kg dexmedetomidine was administrated intravenously within 15 mins after anesthesia induction, and 0.5 μg/（kg?h）was continuously infused till the end of surgery. In group C, equal volume of saline was administrated. Blood glucose, serum cortisol and epinephrine were measured before induction （T0）, at 1 hour after the beginning of surgery （T1）, at extubation （T2）, the first day after surgery（T3）and the second day after surgery （T4）.Results Blood glucose, serum cortisol and epinephrine were lower in group D than those in group C（P0.05或P0.01）.Conclusion Dexmedetomidine could significantly depress the perioperative stress in type two diabetic patients, so blood glucose could be maintained well in these patients during perioperation. 　　【Key words】 Dexmedetomidine; Type two diabete; Blood glucose; Cortisol; Epinephri