老年糖尿病患者在腹腔镜胆囊切除术中的自主神经功能及应激反应变化

摘要

目的 观察老年糖尿病患者在腹腔镜胆囊切除术中的自主神经功能及应激激素水平的变化.方法 选择全身麻醉下行腹腔镜胆囊切除术的胆囊结石患者40例,年龄65 ～ 79岁,平均(72.3±4.1)岁.根据有无2型糖尿病分为2组,糖尿病患者为观察组(n=20),非糖尿病患者为对照组(n=20).分别记录入室后麻醉前(T1)、麻醉诱导插管后(T2)、气腹压力稳定后(T3)和气腹结束缝合皮肤时(T4)4个时间点的平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR),采集相应时间点的心率变异性相关数据低频功率(low frequency power,LF)、高频功率(high frequency power,HF)、总功率(total spectral power,TP),测定血糖(glucose,GLU)和皮质醇(cortisol,COR),观察记录患者低血压、窦性心动过缓等不良反应的发生.结果 观察组T2 ～ T4时MAP、HR较T1时下降,术前FBG、T1 ～T4时GLU、术中窦缓和术中低血压发生率均较对照组高.对照组GLU呈逐渐升高的趋势,观察组GLU呈先下降后升高的趋势.2组患者COR、LF、HF和TP在T2、T3及T4时均较T1时逐渐下降,组间比较差异无统计学意义.结论 老年人的自主神经活性在麻醉状态时受抑制,而老年糖尿病患者在围术期更易发生血流动力学和糖代谢紊乱,合理的麻醉管理可以较好地控制气管插管及手术创伤应激对患者的影响.%Objective To observe the changes of autonomic nervous function and stress response of elderly diabetic patients in laparoscopic cholecystectomy.Methods 40 elderly patients scheduled for selective laparoscopic surgery under general anesthesia were enrolled,aged from 65 to 79,ASA Ⅰ or Ⅱ,and were divided into 2 groups:observation group (patients with type Ⅱ diabetes) and control group (patients with no type Ⅱ diabetes),20 cases in each;the mean arterial pressure (MAP),heart rate (HR) as well as the related data of heart rate variability including low frequency power (LF),high frequency power (HF) and total spectral power (TP) were collected and recorded at each time point:after entering the operating room (T1),after intubation (T2),after pneumoperitoneum pressure reached stable (T3) and when suturing the skin after pneumoperitoneum finished (T4);blood glucose (GLU) and cortisol (COR) were measured and the occurrence of side effects,such as hypotension and sinus bradycardia,was observed and recorded.Results MAP and HR of the cases in observation group were lower within the time from T2 to T4 than those at T1,their levels of fasting blood glucose (FBG) before operation,the levels of GLU within the time from T1 to T4 and the occurrence of hypotension and sinus bradycardia were higher than those of the cases in control group;the GLU level of the cases in control group kept raising while that of the cases in observation group dropped down first and then kept going up;COR,LF,HF and TP of the cases in both groups at T2,T3 and T4 were lower than those at T1,keeping dropping down gradually,the difference between the 2 groups was of no statistical significance.Conclusion The autonomic nerve activity of the elderly people will be inhibited under anesthesia,and the elderly with diabetes are more likely to have hemodynamic disorders and glucose metabolic disorders;an appropriate anesthesia management can better control the impact of endotracheal intubation and surgical stress on the patientas.