蛛网膜下腔麻醉对糖尿病患者周围神经病变的影响

Impact of spinal anesthesia on risk of peripheral neuropathy in patients with diabetes mellitus

关键词:  糖尿病周围神经病变  蛛网膜下腔麻醉  布比卡因  最小感知阈  脑脊液  β-内啡肽  脑源性神经营养因子

Key words:  diabetic peripheral neuropathy  spinal anesthesia  bupivacaine  current perception threshold  cerebrospinal fluid  β-endorphin  brain derived neurotrophic factor

摘要:

目的 探讨糖尿病患者应用局部麻醉药布比卡因实施蛛网膜下腔麻醉，是否增加糖尿病患者周围神经功能损伤风险。方法 选择18例2型糖尿病患者（糖尿病组）及16例非糖尿病患者（非糖组），择期行蛛网膜下腔手术麻醉。麻醉前检测最小感知阈值(current perception threshold, CPT)、留取静脉血和脑脊液用0.75%重比重布比卡因行蛛网膜下腔阻滞麻醉，麻醉10、20min，1、2、4h后测定痛觉平面，4、6、24h行左下肢CPT检测。ELISA法测定血清及脑脊液中脑源性神经营养因子(brain derived neurotrophic factor, BDNF)、β-内啡肽（β-EP）表达水平。结果 与非糖组比较，糖尿病组脑脊液葡萄糖含量明显升高(P<0.01)；脑脊液渗透压明显降低（P<0.01）；血清与脑脊液中β-EP明显降低(P<0.01，P<0.05)；血清中BDNF浓度降低（P<0.05）；其中两组患者自身血清与脑脊液β-EP呈正相关，β-EP的变化与术前左下肢CPT呈负相关。与非糖组比较，糖尿病组麻醉2、4h后阻滞平面升高；糖尿病组麻醉24h后时间点CPT值明显高于麻醉前（P<0.05）。结论 用重比重布比卡因对糖尿病患者实施蛛网膜下腔麻醉，增加了糖尿病患者周围神经损伤风险。

Abstract:

Objective To investigate the impact of spinal anesthesia on the risk of peripheral nerve dysfunction in patients with type 2 diabetes mellitus(T2DM). Methods Eighteen patients with T2DM(diabetic group) and 16 non-diabetic patients(non-diabetic group) undergoing spinal anesthesia for elective surgery were recruited in the study. The current perception threshold(CPT) was tested, peripheral venous blood and cerebrospinal fluid samples were collected before spinal anesthesia. The spinal block levels at 10，20min，1，2，4h and the CPT of left leg at 4，6，24h were recorded after spinal anesthesia with 0.75% hyperbaric bupivacaine. The concentration of brain derived neurotrophic factor(BDNF) and β-endorphin in serum and cerebrospinal fluid were measured by enzyme-linked immunosorbent assay(ELISA). Results Compared with the non-diabetic group，the glucose concentration in cerebrospinal fluid(CSF-GLU) of diabetic group was significantly higher(P<0.01), the osmotic pressure of cerebrospinal fluid was lower(P<0.01), the β-EP concentrations in serum and CSF were significantly lower(P<0.01, P<0.05), the serum BDNF concentration was lower(P<0.01). There was positive correlation between the β-EP concentration in serum and CSF, and negative correlation between the change of β-EP concentration and the basic values of left leg CPT in T2DM patients. The spinal block levels in diabetic group were higher at 2h and 4h, the CPT value at 24h after spinal anesthesia were higher than the basic CPT value(P<0.05). Conclusion Spinal anesthesia with hyperbaric bupivacaine may increase the risk of nerve injury in patients with diabetic mellitus