剖宫产术前禁食禁饮时间对妊娠期糖尿病产妇及新生儿血糖的影响

Effects of preoperative fasting and liquid-fasting time before caesarean section on blood glucose of puerperae with GDM and neonates

目的 探讨两种剖宫产术前禁食禁饮时间对妊娠糖尿病产妇术前、术后血糖、术中并发症及对新生儿血糖的影响.方法 采用前瞻性研究,选取2015年4月1日—2015年9月30日在北京大学第一医院产科行腰硬联合麻醉下剖宫产的162例妊娠期糖尿病产妇作为研究对象,并将其按照入院顺序进行分组,单日入院为对照组,双日入院为观察组.对照组术前禁食固体食物8 h,禁饮透明液体6 h;观察组术前禁食固体食物6 h,禁饮透明液体2 h.比较两组孕产妇术前血糖,术中恶心呕吐、误吸发生率,术中出血量,术后排气时间以及术后半小时血糖,同时比较两组新生儿出生1 min、5 min Apgar评分及出生半小时血糖.采用两独立样本t检验,Mann-WhitneyU检验、χ2检验进行统计学分析.结果 两组产妇术前血糖比较,差异有统计学意义（P〈0.01）.两组产妇术中出血、新生儿出生后半小时血糖比较差异具有统计学意义（P〈0.05）.两组产妇术中恶心呕吐、误吸发生率,术后排气时间,新生儿1 min、5 min Apgar评分比较,差异无统计学意义（P〉0.05）.结论 剖宫产术前禁食固体食物6 h,禁饮透明液体2 h的方案可以减少产妇术前低血糖的发生,维持术后血糖平稳,减少术中出血量,而且没有增加术中恶心呕吐、误吸等并发症和新生儿低血糖的发生.新的禁食、禁饮方案安全,可行,值得临床推广.

Objective To explore the effects of two kinds preoperative fasting and liquid-fasting time before caesarean section on blood glucose of puerperae with GDM before and after the operation,intra-operative complications and on blood glucose of neonates.Methods With prospective study method,162 puerperae with GDM admitted to obstetrical department of Peking University First Hospital and received cesarean section under combined spinal-epidural anesthesia between April 1st and Sep. 30th in 2015,were selected as the research object,and were divided into the control group （admitted on odd-numbered days） and the observation group （admitted on even-numbered days）. Puerperae in the control group were forbidden to eat solid food for 8 h and drink transparent liquid for 6 h before the operation,while those in the observation group were forbidden to eat solid food for 6 h and drink transparent liquid for 2 h before the operation. Puererae in two groups were compared about their preoperative blood glucose,incidence of intraoperative nausea and vomiting or aspiration,intra-operative quality of bleeding,postoperative exsufflation time and blood glucose half an hour after the operation, meanwhile,neonates in two groups were compared about their Apgar scores 1 min and 5 min after birth,and their blood glucose half an hour after birth. Statistical analysis was done by independent-samplest test,Mann-WhitneyU test and χ2 test.Results Difference of preoperative blood glucose of puererae in two groups was statistically significant （P〈0.01）. Differences of intraoperative bleeding of puererae in two groups and blood glucose of neonates half an hour after birth in two groups were statistically significant （P〈0.05）. There was no statistic difference in the incidence of intraoperative nausea and vomiting or aspiration,postoperative exsufflation time of puererae,or Apgar scores 1 min and 5 min after birth of neonates in two groups（P〉0.05）.Conclusions The scheme of forbidding puererae from eating solid food for 6 h and drinking transparent liquid for 2 h before cesarean section can reduce the incidence of preoperative hypoglycemia,maintain a smooth post-operative blood glucose, reduce intraoperative bleeding without increasing the incidence of intraoperative complications like nausea,vomiting or aspiration,or hypoglycemia of the neonates. The new fasting and liquid-fasting scheme is safe and feasible,which makes it worth promoting in clinic.