婴儿唇腭裂修复术中输注不同浓度含糖液的效果分析

Effects of different concentrations of glucose infusion during the cleft lip and palate repair in infant patients

目的:通过监测术中婴儿(2～12月)血糖浓度,探讨输注葡萄糖的可行性。方法:选择美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级标准为Ⅰ～Ⅱ级唇腭裂患儿(2～12月)90例(先天糖尿病患儿除外),按输液成分的不同分为3组:Ⅰ组输注生理盐水,Ⅱ组输注2.5%(质量分数)葡萄糖,Ⅲ组输注5%(质量分数)葡萄糖,均按6～8 mL/(kg.h)输注,即Ⅱ、Ⅲ组术中输注葡萄糖分别为150～200 mg/(kg.h)和300～400mg/(kg.h),每组各30例。患儿入手术室后常规监测心电图(electrocardiogram,ECG)、血氧饱和度(pulse oxygensaturation,SpO2),均吸入七氟烷(Sevoflurane)进行麻醉诱导及维持(诱导后即开始输注液体)。记录患儿的年龄、性别、体重、禁食时间、手术时间及麻醉时间,监测麻醉诱导前(即输注液体前),诱导后10 min、30 min及术毕时的血糖浓度。结果:3组患儿的年龄、体重、性别、禁食时间、麻醉时间、手术时间差异均无统计学意义。3组患儿的麻醉诱导前血糖浓度差异无统计学意义,各组内诱导后血糖浓度均高于诱导前。诱导后Ⅰ组血糖浓度偏低的发生率达13.3%(4/30,2.8～4.3 mmol/L),最低血糖为3.1 mmol/L,未发生高血糖。诱导后Ⅱ组各时间点血糖浓度低于Ⅲ组,高于Ⅰ组,高血糖的发生率为10%(3/30,>11.1 mmol/L),最高血糖浓度为12.7 mmol/L。诱导后Ⅲ组患儿各时间点的血糖浓度高于Ⅰ组及Ⅱ组,高血糖的发生率达70%(21/30,>11.1 mmol/L),最高血糖浓度达22.1 mmol/L。诱导后10 min、30 min及术毕时血糖浓度:Ⅰ组为(5.8±1.3)mmol/L,(8.4±1.7)mmol/L和(10.6±2.8)mmol/L;Ⅱ组为(6.3±1.4)mmol/L,(8.5±2.5)mmol/L和(11.3±2.9)mmol/L;Ⅲ组为(6.6±1.5)mmol/L,(8.2±2.1)mmol/L和(12.2±3.5)mmol/L。结论:婴儿唇腭裂全麻术中以6～8 mL/(kg.h)速度输注2.5%葡萄糖液较为适合,但术中仍应加强血糖浓度的监测。

Objective： To analyze the feasibility of regular infusion with different concentrations of dextrose and blood glucose monitor in infant from 2 to 12 months during operation.Methods： Ninety ASA（American Society of Anesthesiologists）Ⅰ-Ⅱ infants（age 2-12 months） who undertook cleft lip and palate repair（excluding patients with congenital diabetes） were divided into three groups（30 cases per group）.Group Ⅰ patients were infused with normal saline,Group Ⅱ with 2.5%（mass fraction） dextrose in normal saline and Group Ⅲ with 5%（mass fraction） dextrose,all by a rate of 6-8 mL/（kg·h）.Once the patient was sent into the operation room,Electrocardiogram（ECG）and Pulse Oxygen Saturation（SpO2） monitor were applied regularly;and anesthesia was inducted and maintained with sevoflurane in oxygen.The infants＇ age,gender,weight,fasting time,operation time and duration of anesthesia were recorded and the blood glucose concentrations before infusion,10 minutes and 30 minutes after induction as well as at the end of operation were recorded.Results： There were no differences in age,gender,weight,fasting time,operation time and duration of anesthesia among the three groups.The differences of blood glucose concentrations before induction had no statistical significance among the three groups.The blood glucose concentration after induction was higher than that before induction in each group.The occurrence of lower level of blood glucose in Group Ⅰ was 13.3%（4/30,2.8-4.3 mmol/L）,with the lowest value being 3.1 mmol/L.None was detected hyperglycemia.In Group Ⅱ,blood glucose value after induction was lower than Group Ⅲ and higher than Group Ⅰ at every time point and incidence rate of hyperglycemia was 10%（3/30,〉11.1 mmol/L）,with the highest value being 12.7 mmol/L.Blood glucose in Group Ⅲ was higher than both Group Ⅰ and Group Ⅱ after infusion.Incidence rate of hyperglycemia in Group Ⅲ was 70%（21/30,〉11.1 mmol/L）,with the highest value being 22.1 mmol/L.After induciton 5,10 min and the end of operation,blood glucose values with group Ⅰwere（5.8±1.3） mmol/L,（8.4±1.7） mmol/L and（10.6±2.8） mmol/L;group Ⅱ were（6.3±1.4） mmol/L,（8.5±2.5） mmol/L and（11.3±2.9） mmol/L;group Ⅲ were（6.6±1.5） mmol/L,（8.2±2.1） mmol/L and（12.2±3.5） mmol/L.Conclusion： 2.5% dextrose at a rate of 6～8 mL/（kg·h）] is appropriate for infants during cleft lip and palate repair,while regular blood glucose monitor should be applied during operation.