婴幼儿唇腭裂修补术中不同输液成分对血糖和电解质的影响

Different intraoperative fluid administration influences electrolytes and blood glucose levels during cleft lip and palate repair in infants

目的：观察婴幼儿唇腭裂修补术中不同输液成分对血糖和电解质的影响。方法：104例年龄在3个月～2岁的接受唇腭裂修补术的婴幼儿患者,根据术中输液的不同组成分为3组。A组(n=37)：单纯输入5%葡萄糖氯化钠注射液；B组(n=49)：组合输注组,先在25 min内输入5%葡萄糖氯化钠注射液(6ml/kg),然后输注乳酸钠林格注射液；C组(n=18)：单纯输注乳酸钠林格注射液。术中检测血清Na^+、K^+和血糖浓度,并应用SAS 6．12软件进行X^2检验。结果：3组术中Na^+、K^+均无显著性差异(P＞0．05)。3组中,高血糖(＞11．1mmol/L)发生率分别为A组21．62%(8/37例)、B组6．12%(3/49例)和C组0(0/18例)。A组术中血糖的(8．06±2．81)mmol/L,比C组(5．66±1．69)mmol/L显著升高(P＜0．05)。结论：小儿唇腭裂修补术中单纯输注乳酸钠林格注射液或组合输注5%葡萄糖氯化钠注射液+乳酸钠林格注射液,更有利于维持术中血糖稳定和血电解质平衡,术中应监测血糖浓度。

PURPOSE： To observe the electrolytes and blood glucose levels alternation under different fluid administrations during general anaesthesia for cleft lip and palate repair in infants. METHODS： A study was performed in 104 children （age ranged from 3 months to 2 year） who underwent general anaesthesia for cleft lip and palate repair. Three groups were divided on the basis of intraoperative infusion. Group A： glucose 5% sodium chloride solution alone （n= 37）; Group B： Administration of glucose 5% sodium chloride solution （6ml/kg） for 25 minutes and then lactated-Ringer＇s solution later （n=49）; Group C： Lactated-Ringer＇s solution （LR） alone （n=18）. Blood samples were taken at 1 hour after induction of anaesthesia. A series of assays of blood glucose concentration, sodium ion （Na^＋） and kalium ion （K^＋） were done. The data was analysed with SAS 6.12 software package for ANOVA and Chi-square test. RESULTS： There were no significant differences among the 3 groups in K^＋, Na^＋ （P〉0.05）. The incidence of hyperglycaemia in group A, B and C were respectively 21.62% （8/37）, 6.12%（3/49 ） and 0%（0/18）. The blood glucose concentration was significantly higher in group A （8.06±2.81）mmol/L than in group C （5.66±1.69）mmol/L （P〈0.05）. CONCLUSION： Intraoperative administration using lactated-Ringer＇s solution （LR） alone or glucose 5% sodium chloride solution （6ml/kg） and lactated-Ringer＇s solution for infantile cleft lip and palate repair is safe and appropriate due to the rapid surgery process. Perioperative blood glucose levels have to be monitored closely.