高血压患者围手术期胰岛素抵抗

目的 观察高血压患者围手术期胰岛素敏感性的变化规律，探讨高血压病胰岛素抵抗的特点及相关因素。方法 非糖尿病、ASAⅠ∽Ⅱ级全麻下择期手术患者，高血压（A组）27例，非高血压（B组）13例。平衡麻醉下分别在麻醉前、手术开始后1h、术毕拔管后、术后第一天测定空腹血糖、血胰岛素。结果 两组各时相血糖值均高于术前，术后第一天高血压组血糖值较非高血压组明显升高（P〈0．01）。两组血浆胰岛素手术中无明显变化，但至术后第一天显著上升（P〈0．01）。胰岛素敏感指数术中即开始下降，术后第一天降至最低，且高血压组胰岛素敏感性下降幅度大于非高血压组。高血压组术后第一天胰岛素敏感指数较非高血压组低（P〈0．05），且与术前胰岛素敏感指数，手术时间、BMI相关。结论 高血压病术后第一天存在更显著高血糖和胰岛素抵抗，胰岛素抵抗程度与术前胰岛素敏感指数，手术时间、BMI有关。

A Clinical Study on Perioperative Insulin Resistance in Patients with Essential Hypertension

Objective To study the peri-operational changes of insulin sensitivity and the characteristic of insulin resistance in patients with essential hypertension(EH).Methods 27 patients with EH, without diabetes mellitus(group A) and 13 patients without EH and diabetes mellitus(group B),scheduled for surgery under general anesthesia,were enrolled in this study.Blood concentrations of glucose(G) and insulin (I) were measured before anesthesia induction,at 60th min of operation,after tracheal extubation and on the first postoperative day in each groups respectively.Results Blood glucose increased significantly at each time point in two groups.Blood insulin was not significantly different in two groups during operation,but had significant increase on the first postoperative day.Insulin sensitivity index(ISI) of both groups,however,gradually decreased during the operation,which reached to the lowest point on the first operative day.ISI on the first postoperative day in group A was larger than that in group B.ISI in group A significantly decreased than that in group B and related to ISI before anesthesia induction,the surgery time and body mass index.Conclusion Patients with EH developed significant increasing of blood glucose and insulin resistance on the first postoperative day.ISI before anesthesia induction,the surgery time and body mass index are related with the level of insulin resistance on the first postoperative day.