贵州医科大学学报

2019, v.44;No.220(01) 72-75

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围手术期补充含糖液体对手术患者血糖及胰岛素抵抗的影响
Effects of Perioperative Period Infusion of Glucose-crystalloid on Patients' Blood Sugar and Insulin Resistance

刘艳秋,邱军,陈惠,任益民,曾丽,张凯强
LIU Yanqiu,QIU Jun,CHEN Hui,REN Yimin,ZENG Li,ZHANG Kaiqiang

摘要(Abstract):

目的:观察围手术期输注含糖和不含糖晶体液对血糖及胰岛素抵抗的影响。方法:择期2 h左右全麻手术46例,年龄20~50岁,ASA分级Ⅰ~Ⅱ级,随机分为两组,手术期间全程输注钠钾镁钙葡萄糖注射液(含糖晶体液,G组)和输注乳酸钠林格注射液(不含糖晶体液,R组),每组23例;入手术室后两组病人用对应液体以10 mL/(kg·h)的速度为基础静脉输注,由麻醉医师据术前禁食时间、术中不显性蒸发、术中失血情况调整输液速率;于麻醉诱导前(T1)、手术结束时(T2)测定血糖、血酮和胰岛素浓度,并计算胰岛素抵抗指数(IR)。结果:与R组比较,T1时G组血糖水平升高(P<0.05),但血糖值在正常范围内;胰岛素及IR比较,T1和T2时点两组差异均无统计学意义(P>0.05);与T1比较,R组在T2时点血酮水平升高(P<0.05);与R组比较,T2时G组血酮水平降低(P<0.05)。结论:围手术期短时间输注含糖晶体液(1%)能得到满意的血糖浓度和抑制脂肪分解,且不产生胰岛素抵抗。
Objective:To observe the effects of perioperative period replenish of glucose-crystalloid and no-glucose-crystalloid on patients' blood sugar and insulin resistance.Methods:Selecting 46 general anesthesia patients with operation time of about 2 hours,aged 20 to 50 years old;ASA grade I-II,divided randomly into two groups with 23 in each group:sodium potassium magnesium calcium and glucose injection(glucose-crystalloid,group G) and injection of sodium lactate Ringer's injection(noglucose-crystalloid,group R) during the whole surgery.After entering the operating room,both groups received injection at a rate of 10 mL/(kg·h) for intravenous infusion,and rate adjusted by the anesthetist according to the preoperative fasting time,intraoperative not dominant evaporation,intraoperative blood loss.Blood glucose,blood ketone and insulin concentrations were measured pre-anesthesia(T1) and at the end of the surgery(T2),and insulin resistance index(IR) was calculated.Results:Compared with the R group,the blood glucose level of group G was increased(P<0.05),but the blood glucose level was within the normal range.Comparing insulin and IR,T1 and T2 time point of both groups showed no difference(P>0.05).Compared with T1,blood ketone levels of group R improved at T2 time point(P<0.05);compared with the group R,blood ketone levels of group G decreased at T2 time point(P<0.05).Conclusion:Infused crystalloid solution with glucose(1%)within short time during perioperative period can effectively control the blood glucose concentration and inhibit the decomposition of fat,and would not produce insulin resistance.

关键词(KeyWords): 围手术期;补液疗法;糖代谢;胰岛素;胰岛素抵抗
perioperative period;crystalloid solution;glucose metabolism;insulin;insulin resistance

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生计生委科学技术基金资助项目(gzwjkj2017-1-083);; 贵州省2017年大学生创新训练项目(201710660020)

作者(Author): 刘艳秋,邱军,陈惠,任益民,曾丽,张凯强
LIU Yanqiu,QIU Jun,CHEN Hui,REN Yimin,ZENG Li,ZHANG Kaiqiang

DOI: 10.19367/j.cnki.1000-2707.2019.01.014

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