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目的:比较异氟醚吸入全麻复合硬膜外阻滞与异氟醚吸入全麻对食管癌手术患者血糖、胰岛素敏感性指数等的影响。方法:40例食管癌手术患者随机分为异氟醚吸入全麻复合硬膜外阻滞(GEA)组和异氟醚吸入全麻(GA)组,每组20例。分别于麻醉前、手术90min、术毕60min、术后第1天和术后第2天外周静脉采血,测定血糖、血浆胰岛素、去甲肾上腺素、肾上腺素和皮质醇浓度,并计算胰岛素敏感性指数(ISI)。结果:术毕60min时,GEA组血糖、血浆去甲肾上腺素、肾上腺素浓度明显低于对照组(P=0.007,P=0.004,P=0.015)。术后第1天时,GEA组血浆胰岛素、皮质醇浓度明显低于对照组(P=0.035,P=0.042),GEA组的ISI值明显高于GA组(P=0.024)。结论:与单纯全麻相比,全麻复合硬膜外阻滞可减轻食管癌手术患者应激性高血糖反应和术后胰岛素抵抗。
OBJECTIVE: To compare the effects of inhaled general anesthesia with isoflurane and general anesthesia with isoflurane on the blood glucose and insulin sensitivity index of esophageal cancer patients. Methods: Forty esophageal cancer patients were randomly divided into isoflurane inhalation anesthesia combined epidural block (GEA) group and isoflurane inhalation anesthesia (GA) group, 20 cases in each group. Peripheral venous blood samples were collected before anesthesia, 90 min after operation, 60 min after operation, 1 day after operation and 2 days after operation. The concentrations of blood glucose, plasma insulin, norepinephrine, epinephrine and cortisol were measured and the insulin sensitivity Index (ISI). Results: The blood glucose, plasma norepinephrine and epinephrine concentrations in GEA group were significantly lower than those in control group at 60min after operation (P = 0.007, P = 0.004, P = 0.015). On the first postoperative day, plasma insulin and cortisol levels in GEA group were significantly lower than those in control group (P = 0.035, P = 0.042). ISI values in GEA group were significantly higher than those in GA group (P = 0.024). Conclusion: Compared with simple general anesthesia, general anesthesia combined with epidural blockade can reduce stress hyperglycemic response and postoperative insulin resistance in patients with esophageal cancer.