崔海英?范俊柏?马瑞英?温苗苗

【摘要】椎管内麻醉由于阻滞了交感神经，故能抑制机体对手术牵拉等刺激的应激反应，同时肾上腺皮质激素、甲状腺素、儿茶酚胺等分泌均减少，血糖也会出现波动。交感神经阻滞会引起外周静脉血管扩张，回心血量减少，导致血压降低。Apelin是血管紧张素Ⅱ1型受体相关蛋白（APJ）的内源性配体，在体内分布广泛，在许多器官和组织中通过不同的方式参与血压和血糖的调节。Apelin在糖尿病、高血压等代谢综合征的发生发展中起着重要作用。该文就Apelin的功能及椎管内麻醉下Apelin与血压和血糖的关系进行了综述。

【关键词】椎管内麻醉;Apelin;血压;血糖

Research progress on effect of spinal anesthesia and Apelin on blood pressure and blood glucose Cui Haiying， Fan Junbai， Ma Ruiying， Wen Miaomiao. Department of Anesthesiology， the Second Hospital of Shanxi Medical University， Taiyuan 031001， China

Corresponding author， Fan Junbai， E-mail： fjb1971@ 163. com

【Abstract】Spinal anesthesia can inhibit the stress response of the body to surgical pulling and other stimulation due to the blockage of the sympathetic nerve. Meantime， it can also reduce the secretion of adrenal cortical hormone， thyroxine and catecholamine， and lead to the fluctuations of the blood glucose level. Sympathetic block can induce the dilatation of peripheral veins， decrease the blood return and lead to hypotension. As an endogenous ligand of angiotensin Ⅱ type 1 receptor-associated protein （APJ）， Apelin is widely distributed in the body and involved in the regulation of blood pressure and blood glucose in multiple organs and tissues in different patterns. Apelin plays a critical role in the incidence and development of metabolic syndromes， such as diabetes mellitus and hypertension， etc. In this article， the function of Apelin and the relationship between Apelin and blood pressure and blood glucose under subarachnoid anesthesia were reviewed.

【Key words】Spinal anesthesia;Apelin;Blood pressure;Blood glucose

Apelin具有多效性作用，既参与维持葡萄糖稳态和炎症反应，也调节血管系统，是一种重要的生理调节肽，Apelin/血管紧张素Ⅱ1型受体相关蛋白（APJ）系统广泛分布于人体的心血管以及神经内分泌等系统，参与炎症反应、氧化应激、调节激素分泌、维持血管张力和调节心肌收缩力等许多病理生理过程[1]。Apelin与椎管内麻醉对交感神经系统的作用是相互拮抗的，在临床中可发现经椎管内麻醉后患者的血压出现一定程度的降低，血糖也会出现波动，这多由麻醉药物干扰自主神经系统的平衡所致。

一、椎管内麻醉与血糖变化

糖尿病患者本身处于胰岛素相对缺乏状态，因此易于产生高血糖、酮症酸中毒或非酮症高渗性糖尿病昏迷等。椎管内麻醉阻滞了交感神经，能抑制机体对手术牵拉等刺激的应激反应，也会使血糖降低。……