七氟醚和丙泊酚对腹腔镜下行子宫肌瘤切除术患者胰岛功能的影响

目的探讨七氟醚和丙泊酚对腹腔镜下行子宫肌瘤切除术患者胰岛功能的影响。方法选择择期行腹腔镜下子宫肌瘤切除术患者40例,年龄40~55岁,ASAⅠ或Ⅱ级,随机数字表法分为七氟醚组(S组)和丙泊酚组(P组),每组20例。所有患者采用丙泊酚2 mg/kg、舒芬太尼0.5μg/kg、罗库溴铵0.9mg/kg常规麻醉诱导,麻醉维持:S组吸入麻醉维持七氟醚MAC 0.7~1.3,P组靶控输注丙泊酚维持其血浆靶浓度为2.0~5.0μg/ml。术中控制BIS值在40~55,分别检测诱导前(T_0)、手术开始时(T_1)、手术结束时(T_2)的血糖、胰岛素、C肽、胰高血糖素、皮质醇浓度。结果与T0时比较,T_1、T_2时两组患者血糖、胰岛素、C肽、胰高血糖素、皮质醇明显升高(P0.05);与T_1时比较,T_2时两组患者血糖、胰岛素、C肽、胰高血糖素、皮质醇明显升高(P0.05)。T_1、T_2时P组血糖、胰高血糖素、皮质醇明显低于S组(P0.05),胰岛素明显高于S组(P0.05)。结论与七氟醚比较,丙泊酚更能促进胰岛素和C肽的分泌,抑制皮质醇和胰高血糖素的分泌,抑制术中血糖的升高。

Effects on pancreas islet function in patients undergoing laparoscopic myomectomy during sevoflurane and propofol anesthesia

Objective To investigate the effects on pancreas islet function in patients ubdergoing laparoscopic myomectomy during sevoflurane or propofol anesthesia.Methods Forty pa-tients,40-55 years,ASA Ⅰ or Ⅱ scheduled for elective surgery of laparoscopic myomectomy were randomly divided into two groups (n=20 each group).Propofol 2 mg/kg,sufentanil 0.5 μg/kg and rocuronium 0.9 mg/kg were used for induction,BIS was controlled between 40 and 55 during surgery.The anesthesia was maintained with sevoflurane and MAC was maintained with 0.7-1.3 in group S.The anesthesia was maintained with propofol continuous infusion and the plasma concentra-tion of target was set between 2.0 to 5.0μg/ml in group P.Blood glucose,insulin,c-peptide,gluca-gon and cortisol were measured at 3 time points:before induction of anesthesia (T0 ),start of surgery (T1 ),end of surgery(T2 ).Results Compared with T0 ,blood glucose,insulin,c-peptide,glucagon and cortisol in two groups were increased significantly at T1 and T2 (P <0.05).Compared with T1 , blood glucose,insulin,c-peptide,glucagon and cortisol in two groups were increased significantly at T2 (P <0.05).Compared with group S,blood glucose,glucagon and cortisol were increased indis-tinctively and insulin,c-peptide were increased significantly in group P at T1 and T2 (P < 0.05). Conclusion Compared with sevoflurane,propofol could promote the secretion of insulin and c-pep-tide,and inhibit cortisol and glucagon secretion,thus inhibit the rise of intraoperative blood glucose.