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首页> 外文期刊>Acta Anaesthesiologica Scandinavica >High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients
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High thoracic epidural analgesia decreases stress hyperglycemia and insulin need in cardiac surgery patients

机译：胸高硬膜外镇痛可减少心脏手术患者的应激性高血糖和胰岛素需求

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Objective Assuming that high thoracic epidural analgesia (HTEA) with the sympathetic block might decrease postoperative blood glucose (BG) level and reduce the need of insulin, the aim was to evaluate the effect of HTEA on the BG level and insulin requirement in patients undergoing cardiac surgery. Materials and methods Forty-two low-risk patients age 65-79 years scheduled for elective coronary artery bypass grafting with or without aortic valve replacement were randomised to receive HTEA as supplement for general anaesthesia. BG and lactate were measured before and after cardiopulmonary bypass and postoperatively at least every 3 h together with administration of insulin. Postoperative pain was evaluated 30 min, 2, 4 and 6 h after extubation, and before discharge from the intensive care unit. Results Overall BG levels showed great variation over time (P < 0.001). No statistically significant difference was found in perioperative BG, but postoperative lower BG levels were found in HTEA patients (P = 0.042). The number of patients not receiving insulin in postoperative period was significantly higher in HTEA group (9 vs. 2, P = 0.032). No differences were seen in lactate levels. Patients in the HTEA group had significant lower pain scores (P < 0.001). Conclusion HTEA preserves glucose metabolism better and leads to a lesser degree of 'stress hyperglycaemia' in cardiac surgery patients.
机译：目的假设伴有交感阻滞的高胸膜硬膜外镇痛药（HTEA）可能会降低术后血糖（BG）水平并减少胰岛素需求，目的是评估HTEA对心脏手术患者的BG水平和胰岛素需求量的影响手术。材料和方法42例年龄65-79岁，计划行择期冠状动脉旁路移植术或不行主动脉瓣置换术的低危患者被随机分配接受HTEA作为全身麻醉的补充剂。在体外循环前后，术后至少每3小时与胰岛素给予一次一起测量BG和乳酸。拔管后30分钟，2、4和6小时以及从重症监护室出院前评估术后疼痛。结果总体BG水平随时间变化很大（P <0.001）。在围手术期BG中没有发现统计学上的显着差异，但是在HTEA患者中术后BG水平较低（P = 0.042）。 HTEA组术后未接受胰岛素治疗的患者数量明显增加（9比2，P = 0.032）。乳酸水平无差异。 HTEA组的患者疼痛评分明显降低（P <0.001）。结论HTEA在心脏外科手术患者中可更好地保留葡萄糖代谢，并降低“应激性高血糖”程度。

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