| Objective: To observe the changes of blood glucose and the stress reaction in type 2 diabetics under different depth of anesthesia. To explore the influential regularity of stress reaction under different depth of anesthesia and if sevoflurane combined intravenous anesthesia can reduce degree of stress reaction.Methods: Thirty-six ASAâ…¡orâ…¢diabetics with gastric cancer in our hospital were selected and randomly divided into three groups with 12 cases each. each patient's hemodynamic changes were monitored, According to Bispectral index (Bispectral index, BIS) , the depth of anesthesia were modulated and divided into groups such as : comparative shallow anesthesia group of Inhalation-intravenous general anesthesia ( maintaining BIS values of 50-60 ,group A), comparative deep anesthesia group of Inhalation-intravenous general anesthesia (maintaining BIS values of 35-45 during surgery, group B), total intravenous anesthesia group(maintaining BIS values of 40-60 during surgery, group C). Blood samples were obtained from non-blood transfusion side of the elbow before anesthesia (T1), 1h after the beginning of surgery (T2), 2h after the beginning of surgery (T3), 5min after extubation (T4), the following indicators were measured: blood glucose (Glu), epinephrine (EPI), cortisol (Cor). Postoperative patient recovery were followed up .Results: All indicators of patients before anesthesia were comparable, there were no significant differences; In our postoperative follow-up visits, consciousness, muscle strength and respiratory recovery were good, no intraoperative awareness and adverse psychological effect occurred during surgery. Hemodynamic changes: SBP and DBP of three groups were decreased significantly at T2,T3 (P<0.05),and the difference of SBP had a statistical significance (P <0.05),at T2, group A > group B > group C, atT3 , group C > group A > group B , compared with group A and group B, SBP,DBP,HR of group C at T2,T3,T4 , standard deviation all had increased to some extent. Compared with that of T1, Glu, EPI, Cor concentration of T2,T3,T4 ,in three group patients all increased significantly (P <0.05). Three group patients were compared between three groups , the difference of Glu, EPI, Cor concentration had statistical significance at T2,T3,T4 (P <0.05), group C> group A > group B. compared with group A and group B , the change of Glu and the change of C all had a positive correlation ,and the correlation coefficient was 0.020,there was no good correlation between group A and group C, group B and group C; changes of EPI in 3 groups had not a good correlation.Conclusion: According to what BIS monitored, intraoperative hemodynamic monitoring of three group patients under total intravenous anesthesia and Inhalation-intravenous general anesthesia were stable. Postoperative recovery, consciousness, muscle strength and respiratory recovery were good, no intraoperative awareness and adverse psychological effects occurs during surgery. hemodynamic fluctuations of 3 groups were compared, intra-group differences of total intravenous anesthesia group is much larger than that of Inhalation-intravenous general anesthesia and comparative deep anesthesia group of Inhalation-intravenous general anesthesia is larger than comparative shallow anesthesia group of Inhalation-intravenous general anesthesia . However, from the view of the inhibition to total stress reaction of the body, comparative deep anesthesia group of Inhalation-intravenous general anesthesia is larger than comparative shallow anesthesia group of Inhalation-intravenous general anesthesia , and much larger than the total intravenous anesthesia group. |
