转化糖电解质注射液对肝胆手术患者能量代谢的影响

Effect of Invert Sugar Electrolyte Injection on Energy Metabolism in Patients with Hepatobiliary Surgery

目的探讨转化糖电解质注射液对肝胆手术患者能量代谢的影响。方法选择2013年6月至2015年3月在医院行肝胆手术患者90例,随机分为对照组和观察组,各45例。两组患者均常规术前禁食禁饮,行麻醉诱导及维持后,对照组静脉滴注10%葡萄糖注射液250 m L,观察组静脉滴注10%转化糖电解质注射液250 m L,均在30 min内输完且输完后2 h内不再应用其他含糖液体。记录两组患者在输注液体前(T_0)、输液后即刻(T_1)、输注后1 h(T_2)、输注后3 h(T_3)的血压、心率、血糖、胰岛素值、C肽值、血液剩余碱(BE)值、游离脂肪酸(FFA)值的变化及不良反应发生情况。结果 T_1两组患者心率、血压与输液前相比均下降(P<0.05),但组间无统计学差异(P>0.05);T_2对照组心率、血压与输液前相比均显著升高(P<0.05),T_3有所下降,但仍高于T0(P<0.05);T_2和T_3观察组心率、血压恢复平稳,与T0相比差异无统计学意义(P>0.05),与对照组相比,差异有统计学意义(P<0.05)。输液后两组患者血糖、胰岛素均先升高后下降,但观察组波动幅度小于对照组(P<0.05);T_2时观察组已恢复至输液前水平(P>0.05),T_3时对照组仍高于T0和观察组(P<0.05)。输液后,两组患者C肽值均先上升、后下降,BE值先下降、后上升,但观察组患者各时点的波动幅度均小于对照组(P<0.05),观察组T_3时已恢复至T_0水平(P>0.05),对照组未恢复(P<0.05)。观察组FFA值一直平稳,与T_0差异无统计学意义(P>0.05);对照组则逐渐升高,T3时显著高于T_0时及观察组(P<0.05)。两组患者不良反应发生率相当(P>0.05)。结论转化糖电解质注射液用于肝胆手术的患者,可为患者提供基本能量保证,并减少血糖及胰岛素的波动,具有碱化作用并避免了脂肪的分解,且药品相关不良反应少。

Objective To observe effect of invert sugar electrolyte injection on energy metabolism observed in patients with hepatobiliary surgery.Methods 90 cases of patients with hepatobiliary surgery from June 2013 to March 2015 were selected and randomly divided into the control group and the observation group,45 cases in each group.All patients received routine preoperative measures of fasting water,induction and maintenance of anesthesia.The control group received 10% glucose injection 250 m L intravenous infusion,and the observation group received 10% invert sugar electrolyte injection 250 m L intravenous infusion.Both groups finished the injection within 30 min and no other sugary liquids were injected within 2 h after application.The changes of the blood pressure,heart rate,blood sugar,insulin levels,C- peptide infusion,blood base excess( BE) and free fatty acids( FFA) of the two groups at before treatment(T_0),immediately(T_1),1 h infusion( T_2),3 h after infusion( T_3) were recorded and the adverse reactions were observed.Results The heart rate and blood pressure of the two groups at T_1 were significantly decreased compared with that before infusion( P < 0.05),but the difference between the two group was not statistically significant( P > 0.05).The heart rate and blood pressure was significantly higher in the control group at T_2( P > 0.05),and decreased at T_3,but still higher than T_0( P < 0.05).The heart rate and blood pressure of the observation group at T_2 and T_3 became stable,with no significant difference with T_0( P > 0.05),and significant difference with the control group( P < 0.05).After infusion,the levels of glucose and insulin were first increased and then declined,but there was less volatility in the observation group than the control group( P < 0.05); the observation group returned to the level before the infusion at T_2( P > 0.05),while the control group was still higher than T_0 at T_3 and the observation group( P < 0.05).After infusion,the C- peptide values of two groups were increased at first,then decreased,but there was less volatility in the observation group than the control group( P < 0.05),while the observation group restored to pre- infusion level at T_3,and the control group did not restore to pre- infusion level( P < 0.05).FFA value of the observation group had been stable compared with T_0( P > 0.05); the control group gradually increased,the level at T_3 was significantly higher than at T_0 and the observation group( P < 0.05).The adverse reaction rate of the two groups were quite similar,with no statistically significant difference( P > 0.05).Conclusion Invert sugar electrolyte injection for patients with hepatobiliary surgery can guarantee the provision of basic energy and reduce the volatility of blood glucose and insulin with alkalizing effect and avoid the breakdown of fat for patients,and fewer drug- related adverse reactions.