婴幼儿择期手术围手术期胰岛素抵抗及干预措施的初步评价

Peri-operative insulin resistance in infants

目的了解婴幼儿围手术期是否存在胰岛素抵抗及术后胰岛素抵抗的程度，初步探讨相关干预措施对围手术期胰岛素抵抗的影响。方法随机选取接受择期手术的40例婴幼儿，分成实验组和对照组。对照组手术前夜依常规禁食，实验组手术前夜静脉给予葡萄糖至麻醉诱导前约2～3h，葡萄糖输入速度为5mg·kg^-1·min^-1。比较二组手术前后及组间的胰岛素敏感性。结果实验组与对照组手术前后胰岛素敏感性的差异在统计学上具有显著性意义（P〈0．05）；术前二组胰岛素敏感性没有显著差异（P〉0．05），术后实验组和对照组胰岛素敏感性差异具有显著性（P〈0．05）意义。对照组亚组之间手术前后胰岛素敏感性差异没有显著性意义（P〉0．05）。结论婴幼儿择期手术后存在胰岛素抵抗，术前给予适当的糖负荷可以降低婴幼儿择期手术后的胰岛素抵抗。

Objective To assess the effect of pre-operative glucose load on post-operative insulin resistance in infants and neonates. Methods Forty infants undergoing elective surgery were randomized into control group and test group. During the preoperative overnight fasting period, the test group was given 5 milligrams per kilogram per minute of glucose until 2 or 3 hours before the anesthesia in- duction whereas the control group received none. The insulin sensitivity between the two groups were compared. Results Preoperative and postoperative insulin sensitivities were significantly different in both groups（P〈0. 05）. No statistical difference was found in pre-operative insulin resistance between the two groups while significantly statistical difference in insulin resistance was found statistics（P〈 0. 05）between the two groups during the post-operative period. Conclusions The insulin resistance was found after elective operation in infants. It＇s possible to reduce the extent of insulin resistance by pre-operative glucose load.