摘要
目的探讨异丙酚、依托咪酯和异氟醚对胃癌根治术病人围手术期糖代谢、血清白细胞介素-6和皮质醇的影响。方法30例拟行胃癌根治术的病人,随机等分为异丙酚组(A组)、依托咪酯组(B组)和异氟醚组(C组),分别于麻醉前5 min(T1)、麻醉后60 min(T2)、术后30 min(T3)、术后24 h(T4)和术后48 h(T5)抽取病人的静脉血,采用放射免疫技术测定血清IL-6、皮质醇、胰岛素含量;用血糖检测仪测定血糖。结果随着麻醉的延长,血糖逐渐增加(P<0.01),胰岛素逐渐减少(P<0.01),在T3时点血糖达最高、胰岛素达最低;各时点A组的血糖和胰岛素变化均小于B、C组(P<0.05)。各组血清IL-6含量随着麻醉时间的延长逐渐升高,在T4时点达到最高峰,以后逐渐下降;T3、T4时点A、C组IL-6低于B组(P<0.05),T5时点A组IL-6低于B、C组(P<0.001)。随着麻醉时间的延长,A、C组皮质醇逐渐升高,在T3时点达到最高峰,B组逐渐下降,在T4时点达到最低;但在T5时点A组皮质醇低于B、C组(P<0.01)。结论异丙酚对机体内分泌系统的影响最小,对围手术期强烈的应激反应抑制效果最好,异丙酚全静脉麻醉是胃癌根治术较理想的麻醉选择。
Objective To explore the effects of general anesthetics on the glycometabolism serum interleukin-6, cortisol of the gastric cancer patients for radical operations in the perioperitive process. Methods 30 patients scheduled to undergo radical operations for gastric cancer were divided randomly and averagely into propofol group（A）, etomidate group（B） and isoflurane group（C）. Blood samples were drawn from vein at time of 5min before anesthesia （T1）, 60min after anesthesia （T2）, 30min postoperatively （T3）, 24h postoperatively（T4） and 48h postoperatively（T5）. The serum interleuldn-6, cortisol and insulin were measured by radioimmunoassay. Hasma glucose was measured by using the blood sugar measurement apparatus. Results With prolongation of the anesthesia, the plasma glucose had gadually heightened and insulin stepped down after the anesthesia in all groups. At T3 time points plasma glucose reached peak, and the insulin was nadir. At T3-T4 time points plasma glucose was higher and insulin was lower in group A than in group B and C. The scrum IL-6 had gradually increased after the anesthesia in all groups. At T4 time point it was peak. At T3 and T4 time points it was lower in group A and C than in group B （P〈0.05）. At T5 time point it was much lower in group A than in group B and C（P〈0.001）. With prolongation of the anesthesia, the cortisol had gzadually increased in group A and C, and T3 time points reached peak, after at T3 time points gradually recovered. In group B contrasting to in group A and C, the cortisol was lower at T2 -T4 time points than at T1 time point. Conclusions Propofol is more suitable than etomidate and isoflurane for the gastric cancer undergo-ing radical operations, and propofol total intravenous was a better kind of anesthesia for the operations of gastric cancer since it is better to inhibit the stress reaction in the perioperitive process.
出处
《南华大学学报（医学版）》
2008年第4期482-484,487,共4页
Journal of Nanhua University(Medical Edition)
关键词
异丙酚
依托咪酯
异氟醚
胃癌根治术
血糖
胰岛素
IL-6
皮质醇
Propofol
Etomidate
Isoflurane
Radical Operations for Gastric Cancer
Interleukin-6
Cortisol
glycometabolism
