国际麻醉学与复苏杂志   2018, Issue (4): 0-0
    
剖宫产患者术前碳水化合物负荷对术中胰岛素抵抗和新生儿血糖水平的影响
赵知励, 史媛, 于泳浩1()
1.天津市滨海新区大港医院麻醉科
The pre-operation of the csection of the patient with the load on the carbohydrate effect the insulin resistance and the blood glucose level of the newborn
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摘要:

摘要: 目的 评价剖宫产患者术前口服碳水化合物的舒适性以及对术后血糖及胰岛素抵抗的影响。方法 选择2015年3月-2015年7月于天津市总医院择期剖宫产患者共40例为研究对象。分为碳水化合物组(CHO组)和安慰剂组(P组)。两组均采用连续硬膜外麻醉。两组组均常规禁食禁水。手术当日CHO组于术前2小时口服300ml碳水化合物饮品(每100ml饮品含14.1克碳水化合物),P组麻醉前2小时口服等量蒸馏水。产妇血糖、胰岛素、胰高血糖素于饮用碳水化合物及安慰剂2小时后及胎儿娩出后采血送检。利用稳态模式评估法(HOME)测定胰岛素抵抗指数(HOME-IR)与胰岛素敏感指数(HOME-ISI)。胎儿娩出后即刻测定新生儿血糖。同时比较两组患者主观舒适度。结果 碳水化合物组[(1.06±1.06)分]较安慰剂组[(2.52±1.33)分]相比饥饿感有明显改善。在胎儿娩出后,P组胰岛素浓度升高,并且P组胰高血糖素浓度(276.29±159.48)高于CHO组(153.84±150.89),同时P组胰岛素抵抗指数(6.50±3.77)有显著升高,胰岛素敏感性指数(-4.77±0.76)有显著降低(P<0.01)。CHO组(3.52±0.58)新生儿血糖浓度高于P组(2.98±0.60)(P<0.05)。结论 剖宫产产妇术前口服碳水化合物可缓解术前饥饿感,可减轻术中胰岛素抵抗,提高新生儿血糖水平。

关键词: 剖宫产;碳水化合物;胰岛素抵抗;新生儿;血糖
Abstract:

[Abstract]:Objective To evaluate the comfort of cesarean section and the effects of the postoperative blood sugar and the insulin resistance during the operation. Methods From March 2015 to July 2015 in the Genetal hospital of TianJin,40 patients who were going to get elective csection were selected and divided randomly into two groups: oral carbohydrate group(CHO group,n=20),oral placebo group (P group,n=20).Both groups used epidural anesthesia, and a routine preoperative fasting. 300mL carbohydrate drinks(it contains 14.1 grams of carbohydrates per 100ml of drink) was administrated orally 2 hours before anesthesia in oral carbohydrate group.Patients in oral placebo group were given an equal amount distilled waster instead of carbohydrate. The levels of blood glucose (BG)、 plasma insulin(INS)and glucagons were tested after 2 hours and after fetus delivery. According to levels of BG and INS, homeostasis model assessment (HOME)was applied to calculate the index of insulin resistance(HOMA-IR)and insulin sensistivty index(HOMA-ISI).After fetus delivery tested neonates blood glucose immediately. Meanwhile, compared the subjective comfort of the two groups patients.

Key words: csection; carbohydrate; insulin resistance ;newborn; blood glucose