Objective: To study the safety and effectiveness of surgical anaesthesia for patients with diabetes.Methods: Among the 260 cases of surgical patients with diabetes,there were 64 cases with acute cholecystitis,52 cases with gastric perforation,71 cases with suppurative appendicitis,63 cases with appendiceal perforation diffusion peritonitis,and 12 cases of traumatic spleen rupture.146 patients received epidural anesthesia while 116 cases chose general anesthesia.Results: All patients had operation smoothly,with smooth anesthesia.The blood sugar levels were increased to different degree during the anesthesia process when compared with that preoperative.After appropriately increasing the insulin dose according to the rise of blood sugar level,the patients' blood sugar level were controlled in 10-12mmol/L,and Urine ketone bodies(-),without diabetic ketoacidosis,hyperosmolar non-ketotic hyperglycemic coma or Hypoglycaemia.After operation all patients awake timely,and were smoothly decannulated,also with relatively stable blood sugar level.Conclusion: Epidural anesthesia method had lighter effect on surgical patients with diabetes than general anesthesia.

目的 (1)研究0.5%耐乐平连续腰麻用于糖尿病患者下肢手术的安全性和有效性;(2)研究血糖水平对麻醉临床效果的影响。方法 (1)选择糖尿病下肢手术患者60例,随机分为2组。比较2组患者痛觉阻滞程度、最高阻滞平面,运动阻滞程度;(2)观察不同血糖水平对麻醉临床效果的影响。结果 (1)2组患者均可达到完善的镇痛效果,但耐乐平的镇痛起效时间、运动阻滞起效时间、最大运动阻滞时间均比布比卡因显着延长(P<0.05);(2)术前血糖水平<7.8mmol/L麻醉效果最佳,术前血糖水平>11.2mmol/L麻醉效果不佳,有统计学意义(P<0.05)。结论 (1)小剂量0.5%耐乐平连续腰麻用于糖尿病患者下肢手术具有麻醉效果确切,在临床上安全可行;(2)适宜血糖水平麻醉效果好。

Objective: To study and investigate the safety and effectiveness of different ways of anesthesia on the diabetes patients undergoing surgery.Methods: A total of 262 cases of surgical patients with diabetes were selected.Among the patients,146 cases were per-formed waist and epidural anesthesia and 116 cases,general anesthesia.Results: The perioperative blood sugar level and mean insulin doses were less in combined spinal and epidural anesthesia group than in general anesthesia group,with statistical significance(P0.05).In com-bined spinal and epidural anesthesia group,the increased extent of fasting and postprandial blood glucose,glycated hemoglobin levels were less than those in general anesthesia group(P0.05).Through Logistic regression analysis,factors such as age,smoking,drinking and body mass index,except for gender,were highly correlated with the anesthesia effect on diabetes patients(positive).Conclusion: Waist and epidural anesthesia is better for patients with diabetes.

目的观察布托啡诺妇科手术后硬膜外镇痛效果。方法 ASAⅠ～Ⅱ级妇科手术患者40例,随机分为布托啡诺组(B组)和吗啡组(M组),B组用药为0.125%罗哌卡因+0.005%布托啡诺100ml,M组为0.125%罗哌卡因+0.005%吗啡100ml。两组PCEA设置均为背景流速2ml/h,自控剂量2ml/Bolus,锁定时间15min,术后1h、4h、12h、24h、48h双盲观察镇痛评分,采用视觉模拟评分(VAS),常规监测MAP、SpO2、HR、RR,并观察记录不良反应。结果 1)镇痛效应:各时间点VAS评分两组间比较无显著性差异(P>0.05);2)并发症:B组恶心呕吐及搔痒的发生率均低于M组(P<0.05)。结论布托啡诺用于妇科手术后硬膜外镇痛效果确切,恶心呕吐及搔痒的发生率低。