摘要
目的通过观察5%转化糖电解质注射液对神经外科择期手术患者血糖、胰岛素、C肽、游离脂肪酸、碱剩余（base excess,BE）值的影响,评价其对择期手术患者术中能量代谢的影响,探讨转化糖5%电解质注射液在手术中的合理应用,为其临床应用提供一定的参考。方法择期行颅脑手术患者60例,ASA分级Ⅰ～Ⅱ级,麻醉时间〉6h。将患者随机分为3组,即转化糖电解质（invert sugar,IS）组、葡萄糖盐水（glucose solution,GS）组和生理盐水（normal saline,NS）组,每组20例。患者入室后监测无创血压、心率（heart rate,HR）、心电图、氧分压、脑电双频谱指数（bispectral index,BIS）,开放静脉液路,输注乳酸林格液行静脉全身麻醉诱导。于气管插管后行右股静脉穿刺置管,足背动脉穿刺连接传感器行有创动脉血压监测。待循环稳定后,GS、IS、NS组分别给予相应的液体500mL,以8～10mL·k^g-1·h^-1匀速滴注完毕,而后不再给予任何含糖液体。3组受试者分别于输注相应液体前0h（T0）,输注250mL时（T1）,输注后0h（T2）、1h（T3）、3h（T4）,抽取静脉血测定血糖、胰岛素、C肽、游离脂肪酸、BE值,若测得血糖浓度〉10mmol/L,则于液体中加入胰岛素3U。若T3时刻,血糖仍〉10mmol/L,则将其排除本研究,对其监测血糖行胰岛素治疗。记录患者的性别、年龄、身高、体质量指数,抽血即刻的血压、HR、BIS值,术中出血量,术中液体输注量,麻醉时间,术中各组追加胰岛素的例数及百分比。结果 3组血糖均呈从T0～T1升高到T4逐渐降低的过程,升高的峰值都在T1,但升高幅度不同;3组的胰岛素和C肽均先升高后逐渐降低,IS组和GS组升高的峰值在T2,NS组升高的峰值在T1;IS组和GS组的BE值从T0～T3呈逐渐下降,至T4又升高,NS组平稳稍降低。3组的血糖、胰岛素、C肽和BE值在组间、时点间、组间·时点间的交互作用差异均有统计学意义（P〈0.01）。3组游离脂肪酸均有上升和下降波动趋势,但3组游离脂肪酸在组间、时点间、组间·时点间的交互作用差异均无统计学意义（P〉0.05）。结论 5%转化糖电解质注射液易将血糖、胰岛素和C肽水平维持在临床允许范围之内,更适于为择期长时间颅脑手术患者提供能量。
Objective To observe the effect of multiple electrolytic and invert sugar injection on blood glucose,insulin,C-peptide,base excess（BE）,free fatty acids in patients undergoing operation of neurosurgery.To evaluate the effect on energy metabolism in patients and provide experience for clinical application.Methods Sixty patients,ASA Ⅰ-Ⅱ,anesthetic time more than 6hours undergoing elective craniotomy were randomly divided into three groups：invert sugar（IS）group,glucose（GS）group,normal saline（NS）group（n=20）.The patients＇ vital signs were monitored such as non-invasive blood pressure,heart rate（HR）,electrocardiogram,oxygen saturation,the depth of anesthesia（BIS）in operating room.After openning the vein liquid path,the anesthesia was induced. The patients underwent tracheal intubation and mechanical ventilation.The right femoral vein was punctured,and dorsalis pedis artery puncture of invasive arterial blood pressure was monitored.After the circulation stability,GS,IS,NS groups were given sodium chloride and cextrose injection 500 mL,5% multiple electrolytic and invert sugar injection 500 mL and 500 mL physiological saline in one hour,then no sugary liquid was given.Blood glucose,blood insulin,C-peptide,free fatty acid concentrations and BE value were measured at the time of 0hour（T0）before the corresponding fluid infusion,infusion of 250mL（T1）,0hour after infusion（T2）,1hours after infusion（T3）,3hours after infusion（T4）.If the measured blood glucose concentration is higher than 10 mmol/L at T3,then that case will be excluded in the study and will be treated with insulin for measuring blood glucose.The patients＇ gender,age,weight,BMI,blood pressure, HR,BIS immediately at drawing blood were recorded.Bleeding and infusion with liquid in operation were amounted.The number and percentage of patients who got additional insulin was amounted.Results The blood glucose was increased from T0,reached the peak at T1 and was decreased to T4 in the three groups.But the increased extent was different.The insulin,C-peptide in the three groups were all increased and then decreased.The peak increased in IS and GS group was at T2,but in the NS group was at T1;BE values in IS group and GS group were decreased gradually from T0-T3 and were increased at T4.In NS group BE values were decreased from T0-T3 and increased at T4.There were statistically differences in the blood glucose,insulin,C-peptide and BE values in the three groups,the time point,and the interaction of groups and time points（all P〈0.01）.The trendency of free fatty acids in the three groups were with rising and falling trend of fluctuations.But there were no statistically differences in the three groups,the time point,the interaction of groups and time points（P〈0.05）.Conclusion Infusion of 5% multiple electrolytic and invert sugar injection will cause the increasment in blood glucose,insulin,C-peptide levels,but it is in clinical allowed range,which will be good to provide energy for patient with elective craniotomy.
出处
《河北医科大学学报》
CAS
2016年第4期435-439,共5页
Journal of Hebei Medical University
