The Effect Of Combined General-epidural Anesthesiaon Postoperative Insulin Resistance In Patients Undergoing Pulmonary Lobectomy.

Objective: The purpose of this study was to investigate the effect of combined general-epidural anesthesiaon postoperative insulin resistance in patients undergoing pulmonary lobectomy .Methods: Twenty patients undergoing pulmonary lobectomy at half past eight, which had no signs of HBP,DM,liver function failure and renal failure , no significant difference existed between two groups in ASA grade,age,body height and BMI value,were randomly divided into two groups of 10 patients each: GroupG received combined inhale-intravenous anesthesia only during the operation. Group GEAreceived combined inhale-in-travenous anesthesia and at the same time 3.75 g·L-1 Ropivacaine was given through thoracic epidural cavity during the operation. MAP,HR and accumulated dose of Fentanly and propofol were recored .Blood samples were taken from vein for determination of plasma blood sugar,insulin,cortisone, concentrations before induction of anesthesia (T₀) incision(T1 ), when the thoracic cavity was explored (T3),and at the moment of resecting the pulmonary lobe (T4), at the end of the operation (T₅) ,24h after the end of the operation (T6).The determination of the concentrations of fasting plasma glucose(GOD-PAP) and insulin(radio-immunoassay).The value of ISI was determined with the formula introduced by Li Guangwei which calculate the value of ISI with the reciprocal of the cross product of BS and insulin value. Statistics treatment:The measurement data was expressed as "x±s", and using Independent-Samples T Test program and One-Way ANOVA program of SPSS 13.0 software to analyze it.when the value of "p" is lower than 0.05,it has significance.Results: The age,body height,body weight,value of BMI and operation time had no significant difference in both groups (P >0.05) . The concentrations of blood sugar,insulin,cortisone,value of ISI at T₀ had no significant difference in both groups (P >0.05) . The concentrations of blood cortisone increased significantly compared to in Group G than those in Group GEA at T2T3T5T6 . (P < 0.01orP < 0.05).The concentrations of blood sugar,Insulin was higher in Group G at T₀ than at T₂ and T₃-T6 ,or at the same time in Group GEA. Insulin was significantly higher in Group G at T₃ than that in Group GEA (P<0.01).The value of ISI at T₁ to T₆ was significantly lower in both groups compared to baseline(T₀) and was significantly higher in GEA group than that in G group(P<0.05).Conclusion: Combined general epidural anesthesia can alleviate postoperative insulin resistance in patients undergoing pulmonary lobectomy by inhibiting plasma blood sugar,insulin,Cortisol...