术中静脉输注葡萄糖和胰岛素对食管癌患者物质能量代谢的影响

 者物质能量代谢的影响。方法 选择限期于硬膜外阻滞复合全麻下行剖胸食管癌手术患者20例，ASA Ⅰ~Ⅱ级，年龄25~60岁，性别不限，随机分为干预组和对照组，各10例。干预组于外科切皮起输注50%葡萄糖（glucose，Glu）溶液（0.5 g·kg^-1·h^-1）和正规胰岛素（regular insulin，RI，初始剂量为Glu∶RI=1 g∶1~1.5 IU，之后按测得的血糖调整胰岛素用量）直至手术结束；对照组则输注等容量生理盐水。监测直肠温度、血糖、血浆游离脂肪酸（free fatty acid，FFA）、血钾及术后24 h尿素氮定量。结果 两组患者直肠温度均呈下降趋势，组间差别无统计学意义。对照组血糖浓度在术始至术后2 h逐渐升高；干预组术中血糖浓度较术前有所升高，术后1、2 h血糖浓度与术前相比无统计学差异。干预组血浆FFA浓度与对照组相比，在术中30、90、120、150 min及术后2 h显著降低（P<0.05）。干预组术中1、2 h及术后1、2 h血钾浓度与术前相比均有显著下降。术后24 h尿素氮定量两组间无统计学差异。结论 对于硬膜外阻滞复合全麻下行剖胸食管癌手术的患者，术中输注葡萄糖和胰岛素不能减轻术中深部体温下降，但是可能有抑制脂肪分解的作用。

Effect of intraoperative glucose and insulin infusion on the metabolism in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block

Objective To study the effect of intraoperative glucose and insulin infusion on the metabolism in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block. Methods Twenty ASA physical status Ⅰ-Ⅱ adult patients undergoing esophageal cancer surgery were studied. Ten patients received an iv glucose infusion at 0.5 g·kg~(-1)·h~(-1) and insulin infusion (1-1.5 IU ∶ 1 g glucose) throughout the anesthesia. Ten control subjects received isovolumic nutrient-free saline solution. Rectal temperature, plasma glucose concentrations, plasma free fatty acid (FFA) concentrations, plasma potassium concentrations and 24 hour urea nitrogen were measured perioperatively. Results No statistical difference was observed in rectal temperature and 24 hour urea nitrogen between the two groups. The plasma glucose concentrations continued to increase perioperatively in the control group. The glucose concentration increased during the operation in the glucose/insulin group, but the glucose concentrations at 1 and 2 hours after the operation were not statistically different from that before operation. Significant difference in plasma FFA concentration was found perioperatively (30, 90, 120, 150 min during the operation compared with 1 h after operation) between the two groups. In the glucose/insulin group, there was a significant decrease in the concentration of plasma potassium at 1 and 2 h during and after the operation. Conclusions Intraoperative glucose and insulin infusion cannot prevent hypothermia in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block, however, it may reduce lipoclasis.