摘要
目的观察颅内幕上肿瘤切除术患者在围手术期应用糖皮质激素地塞米松和甲泼尼松对血糖的影响。方法选择择期开颅幕上肿瘤切除术患者60例，随机分为三组：甲泼尼松组（M组，n=20）、地塞米松组（D组，n=20）和生理盐水组（N组，n=20），分别于麻醉诱导前静脉注射甲泼尼松1．5mg／kg（5m1）、地塞米松0．2mg／kg（5m1）或生理盐水5ml。术中持续监测有创动脉平均压（MAP）、心率（HR）、脑电双谱指数（BIS）；分别于诱导前（麻醉前基础值）、诱导后1h、2h、4h、6h及24h时取动脉血测定血糖水平。结果M组和D组均可使患者血糖升高，M组在用药2h时血糖达最高值（7．2±0．5）mmoL／L，D组在用药4h时血糖达最高值（7．5±0．5）mmol／L，M组与N组比较在2h、4h差异有统计学意义，D组与N组比较在4h、6h时差异有统计学意义。各组患者血糖在诱导后24h时基本恢复至术前水平。结论甲泼尼松和地塞米松均可使幕上肿瘤切除术患者围术期血糖升高，甲泼尼松血糖升高峰值时间早于地塞米松，血糖下降的时间也早于后者。
Objective To compare the effect of single dose dcxamethasone and methylprednisolone on arterial blood glucose in patients undergoing craniotomy for supratentorial tumors. Method 60 ASA I- II patients undergoing craniotomy were randomized into three groups ：methylprednisolone group（ M group, n = 20）, dexamethasone group（D group, n = 20） and control group （N groups, n = 20）. Dexamethasone 0. 2 mg/kg, methylprednisolone 1.5 mg/kg and normal saline were administrated before induction, respectively. Mean arterial blood pressure （MAP）, heart rate （HR） and bispectral index （BIS） were monitored during operation. BIS was maintained at 40-50. Arterial blood glucose were measured at before induction,1 h,2 h,4 h,6 h after induction and 24 h after induction. Results Arterial blood glucose in M group and D group increased significantly after induction,whereas much higher level in D group at the same point of 4 b and 6 h among groups（ P 〈0. 05）. The peak level was found at 4 h in D group（7. 5 ±0. 5） mmol/L,and 2 h in M group（7. 2 ±0. 5） mmol/L There was different in blood glucose between D group and N group at 4 h and 6h. There was different in glucose between M group and N group at 2 h and 4 h, respectively. Blood glucose returned to the level at presurgery in all cases. Conclusions Arterial blood glucose in patients undergoing craniotomy for supratentorial tumors increases significantly with single dose dexmethasone and methylprednisolone treatment. It is less effect on blood glucose when compared methylprednisolone with dexmethasone.
出处
《中华神经外科杂志》
CSCD
北大核心
2010年第1期62-64,共3页
Chinese Journal of Neurosurgery
关键词
糖皮质激素
地塞米松
甲泼尼松
血糖
脑肿瘤
Glucosteroid
Dexmathasone
Methylprednisolone
Blood glucose
Brain neoplasms
