胸段硬膜外镇痛对开胸手术病人血糖、胰岛素和皮质醇水平的影响

目的　观察胸段硬膜外镇痛 (TEA)对开胸手术病人血糖、胰岛素和皮质醇水平的影响。方法　 2 0例在地氟醚麻醉下行开胸手术病人 ,随机分为TEA组和对照组。于麻醉前、术中 90分钟、术毕 6 0分钟和术后第 1、2、3天测定血糖、胰岛素及皮质醇浓度 ,计算胰岛素敏感性指数。结果　两组病人血糖均自术中 90分钟时明显升高 ,术毕 6 0分钟达峰值 ,术后第 1、2天仍居高不下 (P<0 0 5或P <0 0 1)。TEA组术中及术后胰岛素水平无明显改变 ;对照组术后第 1、2天胰岛素水平升高明显 (P <0 0 5或P <0 0 1)。TEA组病人皮质醇仅术毕 6 0分钟时明显升高 (P <0 0 5 ) ,而对照组于手术中 90分钟明显升高 ,并持续到术后第 1、2天 (P <0 0 5 )。两组胰岛素敏感性指数均明显下降 (P <0 0 5 ) ,于术后第 3天TEA组恢复接近麻醉前水平 (P >0 0 5 ) ;而对照组至术后第 3天仍低于麻醉前值 (P <0 0 5 )。结论　TEA可缓解开胸手术应激反应 ,减轻术后糖代谢紊乱。

Effects of thoracic epidural analgesia on blood levels of glucose,plasma insulin and cortisol in patients undergoing thoracic surgery

Objective To investigate the effect of thoracic epiduralanalgesia （TEA） on blood glucose，plasma insulin and cortisol levels in patients undergoing thoracic surgery．Methods Twenty ASA Ⅰ or Ⅱ patients under general anesthesia with 1.0MAC desflurane were randomly divided into two groups．Patients in TEA group received TEA postoperatively while in the control group did not．The levels of blood glucose，plasma insulin and cortisol were observed at five time points：before anesthesia，at 90min after incision，at 60min after the end of surgery，on the lst，2nd and 3rd postorperative days．The index of insulin sensitivity was calculated．Results The levels of blood glucose were increased significantly at 90min after incision and kept at the high levels till the 2nd postoperative day in both groups（P＜0.01 or P＜0.05）．The levels of plasma insulin were significantly elevated on the lst and 2nd postoperative days （P＜0.01 or P＜0.05）in the control group，but not in TEA group．The levels of plasma cortisol in control group increased significantly at 90min after incision till the 2nd postoperative day （P＜0.05）．The insulin sensitivity index decreased significantly at 90min after incision （P＜0.05） in both groups，which was still lower （P＜0.05）on the 3rd postoperative day in control group，but not in TEA group （P＞0.05）．Conclusion TEA may alleviate the stress response to thoracic surgery and the disturbance of glucose metabolism．