摘要： 目的探讨糖尿病患者甲状腺切除术中使用地塞米松对血糖的影响。方法选择中国医科大学附属盛京医院2016年12月至2018年9月择期行甲状腺良性肿物切除术的糖尿病患者90例，随机均分为研究组和对照组，每组45例。2组均采用全身麻醉，研究组麻醉过程中使用地塞米松（0.11 mg/kg），对照组给与同样剂量的生理盐水。记录2组术前（T0）空腹血糖，地塞米松给药后2 h （T1）、4 h （T2）、24 h （T3）血糖，视觉模拟评分（VAS）；术后额外增加胰岛素量，术后第1天VAS及不良反应发生情况。结果与术前比较，2组地塞米松给药后4 h血糖水平均明显升高（均P<0.05）；而且研究组血糖明显高于对照组（P<0.05）。地塞米松给药后24 h 2组血糖均恢复至术前水平。与对照组比较，研究组地塞米松给药后2 h、4 h VAS评分均明显降低（均P<0.05），而地塞米松给药后24 h 2组VAS评分比较无统计学差异（P> 0.05）。2组均未额外增加胰岛素，术后不良反应（恶心、呕吐）发生率比较差异无统计学意义（P> 0.05）。结论糖尿病患者甲状腺良性肿物切除术中使用地塞米松（0.11 mg/kg），可有效减轻患者术后疼痛；虽然术后4 h时患者血糖一过性增高，但处于可接受范围，并于术后24 h恢复至术前水平。

地塞米松对糖尿病患者甲状腺切除术围术期血糖的影响

商丽华¹, 王翔宇², 龙波¹

1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004;
2. 河南科技大学第一附属医院新区医院麻醉科, 河南 洛阳 471000

收稿日期:2021-05-24出版日期:2022-05-30发布日期:2022-05-28
通讯作者:龙波
作者简介:商丽华(1993-),女,医师,硕士.



关键词: 地塞米松, 糖尿病, 甲状腺切除术, 血糖
Abstract: Objective To investigate the effect of dexamethasone on blood glucose in patients with diabetes mellitus undergoing thyroidectomy for benign thyroid neoplasms. Methods Patients with diabetes mellitus who underwent selective thyroidectomy under general anesthesia between December 2016 and September 2018 were selected from Shengjing Hospital of China Medical University. Ninety patients were randomly divided into experiment group and control group,with 45 patients in each group. The experiment group was given 0.11 mg/kg dexamethasone during anesthesia administration. The control group received the same dose of normal saline. Records included blood glucose at preoperative fasting (T0),postoperative 2 h (T1),4 h (T2) and 24 h (T3). Visual analog scale (VAS) was assessed at T1,T2 and T3;additional postoperative insulin dosage and incidence of adverse reactions were recorded. Results Compared to the preoperative baseline,glucose levels in both groups increased significantly at postoperative 4 h (both P< 0.05),in which the experiment group was significantly higher than the control group (P< 0.05). However,the glucose levels in both groups returned to the preoperative levels at postoperative 24 h. Compared to the control group,VAS scores in experiment groups were significantly decreased at 2 h and 4 h postoperatively (P< 0.05). There was no significant difference in VAS scores between the two groups at 24 h postoperatively (P> 0.05). No additional insulin was added in both groups. There was no significant difference in the incidence of postoperative adverse reactions (nausea and vomiting) (P> 0.05). Conclusion Dexamethasone (0.11 mg/kg) can effectively relieve postoperative pain in patients with diabetes during benign thyroidectomy. Although the patient had a transient increase in blood glucose at 4 h postoperatively,it was still within the acceptable range and returned to the preoperative levels at postoperative 24 h.
Key words: dexamethasone, diabetes mellitus, thyroidectomy, blood glucose
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