全麻下泌乳素型垂体腺瘤切除中血流动力学和糖代谢的变化

为观察全麻下泌乳素型垂体腺瘤患者在不同手术入路下的应激变化 ,将 31例择期手术的泌乳素型垂体腺瘤病人按手术入路分为经蝶组 (S ,n =1 6)和经额组 (F ,n =1 5)。S组以入室 (T1 )、气管插管 (T2 )、放置鼻镜 (T3)、凿鞍底骨板 (T4 )为观测点 ,F组以入室 (T1 )、气管插管 (T2 )、剥离骨膜 (T3)、锯骨 (T4 )为相应对照观测点 ,在这 4点记录平均动脉压 (MAP)和心率 (HR) ,并测定血糖 (GLU)、胰岛素 (INS)和胰高血糖素 (GLA)。S组组内T2时MAP、GLA显著降低 (P <0 .0 5,P <0 .0 1 ) ,T3时HR、GLU显著升高 ,INS及GLA显著降低 (P <0 .0 1 ) ,T4时MAP下降、GLU升高、INS和GLA显著下降 ,GLU、HR显著升高 (P <0 .0 5,P <0 .0 1 ) ;F组组内T2时MAP和GLA显著下降(P <0 .0 5,P <0 .0 1 ) ,T3时GLU显著升高 ,GLA显著降低 (P <0 .0 5) ,T4时HR、GLU显著升高 ,INS显著降低 (P <0 .0 5,P <0 .0 1 )。S组和F组比较 ,仅于T3时心率变化有显著性差异 (P <0 .0 5)。提示泌乳素型垂体腺瘤患者在经蝶入路和经额入路手术下 ,血流动力学和糖代谢指标变化无显著性差异

Changes in Hemodynamics and Glycometabolism Undergoing Microsurgical Removal of PRL-secreting Pituitary Adenoma in General Anesthesia

To observe the influences of different approaches on stress reaction upon general anesthesia, thirty-one patients ASA grade Ⅰ-Ⅱ, scheduled for selective neurosurgery, were allocated into two groups according to transsphenoidal approach and transcranial approach. Group S(n=16)underwent transsphenoidal approach and group F(n=15)did transcranial approach. Observing points were made at inducting(T1), intubating(T2), placing Hardy-Cushing′s Scope(T3), and destroying the bone of bottom sella(T4)in group S; and at inducting(T1), intubating(T2), peeling off periosteum(T3), sawing skull(T4)in group F. Plasma glucose, serum insulin and glucagon were measured. The value of mean arterial pressure and heart rate were recorded. ln group S,MAP and GLA decreased significantly at the period of T2; and HR, GLU, GLA changed significantly at the period of T3(P<0.01); MAP and INS, and GLA significantly decreased and GLU increased significantly at the period of T4. In group F, MAP and GLA decreased significantly at the period of T2; GLU increased and GLA decreased at the period of T3; HR and GLU increased significantly, and INS decreased significantly at the period of T4(P< 0.01). There are no significant changes in hemodynamics and glycometabolism undergoing transsphenoidal approach and transcranial approach.