新生児, 乳幼児の手術侵襲に対する血漿膵グルカゴン, インスリン, 血糖値の変動について : 特に新生児膵グルカゴン値について

抄録

In order to investigate pancreatic function in children, especially in infants and newborns during the surgery, the changes of plasma pancreatic glucagon (IRG), insulin (IRI), and blood glucose (BS) levels were examined in pre-, intra- and post-operative situations by the radio-immunoassay using specific antibody to pancreatic glucagon G-8, insulin antibody and technicon autoanalyzer. Lactated Ringer's solution and 5% glucose solution during the surgery and maintenance fluid including 5% glucose solution in the postoperative course were infused. Preoperative levels were obtained from the saphenous venous blood at 20 minutes after the initiation of anesthesia. In 8 infants (Group A) ; from 1 month to 2 years of age, anesthesia was performed with NLA (neuroleptanesthesia) for 5, GOF (gas-oxygen-fluothane) for 3. In all 6 newborns (Group B) ; from 1 day to 26 days of age, anesthesia was performed with NLA. During anesthesia, no episode of hypoxia or hypotention were observed. Operative procedures were major or moderate degree of the abdominal surgery. In infants (Group A), plasma pancreatic glucagon levels showed about a 100% rise at 30 minutes after the initiation of surgery, a gradual decrease at 90 minutes and a return to the preoperative level at 6 hours after the surgery. Blood glucose level markedly rose during operation, while insulin level did not change during surgery but increased slightly 6 hours postoperatively. In the infant cases, catecholamines increased by surgical stress may be the direct stimulator to increase the pancreatic glucagon level during surgery. Hyperglucagonemia on the 3th postoperative day may be provided by starvation and metabolic change due to surgical stress. On the other hand in the newborns (Group B), blood glucose level markedly increased during surgery as in the infants, but glucagon and insulin levels showed no statistical change. These results may suggest that the early newborns have no matured mechanism of pancreatic glucagon secretion in response to surgical stress.