关争梅 高宏凯 高艳红 梁昂 高相楠 张利岩

　　基金项目：武警总医院科研基金资助课题(WJ2008026)

　　作者单位：100039北京，辽宁医学院武警总医院研究生培养基地

　　通讯作者：张利岩，E-mail:zhangliyan757@sina.com

　　【摘要】  目的  观察实施胃转流手术(GBP)治疗的T2DM患者麻醉期间血糖、血清胰岛素及血清C-P的变化规律。  方法  41例行GBP术的T2DM患者，分别于术前、麻醉开始、麻醉后60 min、120 min、麻醉结束抽取静脉血测定血清C-P、血清胰岛素含量，采用雷兰实时显示动态血糖监测系统(DGMS  Real-Time)监测手术全程血糖水平变化。  结果  DGMS? Real-Time图谱显示：自气管插管开始，血糖水平呈逐渐升高趋势。与术前相比，麻醉期间各时间点血清C-P数值及血清胰岛素数值整体呈下降趋势，尤以麻醉后60 min数值最低。其中有1例患者发生低血糖，13例患者血糖高于10 mmol/L。  结论  胃转流手术患者麻醉期间，由于手术创伤等应激反应减少了机体胰岛素的合成和分泌，干扰了机体的糖代谢，导致血糖升高。

　　【关键词】胃转流手术;血糖;血清胰岛素;血清C-肽

　　doi:10.3969/j.issn.1006-6187.2012.04.004

　　The changing law of blood glucose, serum insulin and C-peptide levels during general anesthesia of gastric bypass surgeryGUAN Zheng-mei, GAO Hong-kai, GAO Yan-hong, et al. Postgraduates′ Training Centre, General Hospital of Armed Police Forces, Liaoning Medical University, Beijing 100039, China

　　Corresponding author: ZHANG Li-yan, E-mail:zhangliyan757@sina.com

　　【Abstract】  Objective  To observe the changing law of blood glucose, serum insulin and C-peptide during the general anesthesia of gastric bypass surgery (GBP) in type 2 diabetic patients.  Methods  In forty-one patients with T2DM undergoing GBP the serum insulin and C-peptide were measured at 5 time-points: pre-operation, beginning of anesthesia, 60min after anesthesia, 120min after anesthesia and anesthesia end. The real-time dynamic glucose monitoring system (DGMS? Real-Time) was used to monitor the blood glucose level in the whole operation time.  Results  Since the endotracheal intubation, blood glucose value was gradually increased. Compared with pre-operation, the serum insulin and C-peptide values at each time-point of anesthetic period were decreased, especially at 60min after anesthesia. There was one patient developing hypoglycemia and 13 patients with a blood glucose higher than 10 mmol/L.  Conclusion  The synthesis and secretion of insulin of T2DM patients may reduce during general anesthesia during GBP because of the stress reaction, which will interfere with the body\'s metabolism and finally lead to blood glucose elevation.

　　【Key words】Gastric bypass; Blood glucose; Serum insulin; Serum C-peptide

【中国糖尿病杂志，2012，20（4）：254-256】