Use of the artificial beta cell during anesthesia for surgical removal of an insulinoma.
Use of the artificial beta cell during anesthesia for surgical removal of an insulinoma.
复制标题
在麻醉过程中使用人工 β 细胞进行胰岛素瘤切除手术。
DOI：
10.1213/00000539-198012000-00013
复制
发表时间：
1980
影响因子：
5.7
通讯作者：
L. Valenta
中科院分区：
文献类型：
--
作者：
J. Pulver;B. Cullen;D. R. Miller;L. Valenta
胰岛素瘤是胰腺β细胞的胰岛素分泌肿瘤，由Harris于1924年首次描述。胰岛素瘤通常与惠普尔三联征有关，惠普尔三联征包括：（1）与之相关的症状性低血糖反复发作史，（2）伴随血糖水平低于50 mg/100 ml，（3）通过给予葡萄糖缓解症状。胰岛素瘤的诊断是通过有症状的禁食、甲苯磺丁脲激发、动脉造影和通过放射免疫测定法测量的不适当升高的空腹血浆胰岛素水平来进行的。由于维持正常血糖水平的困难，胰岛素瘤手术切除的麻醉给药具有挑战性。严重的低血糖可发生在肿瘤的操作过程中，而血糖水平的显着升高可能发生在成功切除肿瘤。在没有重复血糖测定的情况下，由于麻醉和手术刺激的掩蔽效应，这些水平的临床评估是极其困难的。此外，在没有胰岛素分泌肿瘤的情况下，麻醉和手术可能导致血糖浓度的大幅波动。人工β细胞（Biostator，Miles Laboratories，埃尔克哈特，印第安纳州）的最新发展允许通过该装置分析血糖的能力来改善对胰岛素瘤患者的控制
An insulinoma is an insulin-secreting tumor of the pancreatic beta cells, first described by Harris in 1924.' Classically an insulinoma is associated with Whipple's triad, which consists of: (1) a history of repeated episodes of symptomatic hypoglycemia associated with, (2) concomitant blood glucose levels less than 50 mg/100 ml, and (3) relief of symptoms by the administration of glucose.' Diagnosis of insulinoma is made by symptomatic fasting, tolbutamide challenge, artenography, and inappropriately elevated fasting plasma insulin levels measured by radioimmunoassay. The administration of anesthesia for surgical removal of an insulinoma is challenging due to difficulties involved in maintenance of a normal level of blood glucose. Profound hypoglycemia can occur during manipulation of the tumor, whereas a marked elevation in blood glucose levels may occur following successful extirpation of the tumor. In the absence of repetitive blood glucose determinations, clinical assessment of those levels is extremely difficult due to masking effects of anesthesia and surgical stimulat i ~ n . ~ Furthermore, wide swings in blood glucose concentrations may result from anesthesia and surgery in the absence of a n insulin-secreting tumor. The recent development of a n artificial beta cell (Biostator, Miles Laboratories, Elkhart, IN) allows for improved control of patients with insulinomas through the device's ability to analyze blood glucose