糖尿病患者术中输注钠钾镁钙葡萄糖注射液的可行性评估  

Feasibility evaluation of intraoperative infusion of sodium,potassium,magnesium,calcium,and glucose in patients with diabetes mellitus

作　　者：张健[1] 曹苏[2] ZHANG Jian;CAO Su(Department of Anesthesiology, Haimen People’s Hospital, Haimen 226100, Jiangsu, China;Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu, China)

机构地区：[1]海门市人民医院麻醉科,海门226100 [2]南通大学附属医院麻醉科,南通226001

出　　处：《中国临床医学》2018年第6期949-953,共5页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨2型糖尿病患者术中输注钠钾镁钙葡萄糖注射液的可行性。方法:选择腰-硬联合麻醉行下肢手术的2型糖尿病患者32例,均为美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级。观察组输注钠钾镁钙葡萄糖注射液500mL,对照组输注乳酸钠林格注射液500mL,维持输液速度平稳,1h内输注完成。采集手术前日晨(T0)、开始输液即刻(T1)、输液开始后30min(T2)、输注完液体即刻(T3)、输注完液体后30min(T4)和出手术室前(T5)等时间点的血流动力学、血电解质、血糖、血酮、动脉血气指标。结果:观察组和对照组各16例。与术前相比,对照组和观察组血糖值(T2～T5)均升高,差异有统计学意义(P<0.05);与对照组相比,观察组血糖值(T2～T5)升高幅度明显,差异有统计学意义(P<0.05)。对照组血酮值(T3,T5)升高,观察组血酮值(T3,T5)降低,差异有统计学意义(P<0.05)。两组循环指标、乳酸、碱剩余(BE)、pH值和电解质差异无统计学意义。结论:糖尿病患者术中稳定输注少量(500mL)钠钾镁钙葡萄糖注射液,可减少酮体生成,但血糖升高明显,不宜常规输注。Objective:To evaluate the feasibility of intraoperative infusion of sodium,potassium,magnesium,calcium,and glucose in patients with type2diabetes mellitus(T2DM).Methods:Thirty-two T2DM patients received lower extremity surgery under spinal anesthesia(ASAⅠ-Ⅱ)were randomly divided into the control group and the trial group.Patients in the control group were given sodium lactate Ringer’s injection(500mL),and patients in the trial group were given sodium,potassium,magnesium,calcium and glucose injection(500mL).The infusion was maintained at a steady speed and completed in1hour(60±5min)with control system in both groups.The levels of hemodynamics,blood electrolytes,blood glucose,blood ketone,and arterial blood gas were detected at the time points of the morning before operation(T0),immediately after the start of infusion(T1),30min after the start of infusion(T2),immediately after the infusion of crystal liquid(T3),30min after the infusion of crystal liquid(T4),and before leaving the operating room(T5).Results:Compared to the preoperative(T1)values,the levels of blood glucose(T2-T5)of the control group(n=16)and the trial group(n=16)were significantly higher,the differences were statistically significant(P<0.05).The levels of blood glucose(T2-T5)of the trial group were significantly increased compared to the control group(P<0.05).The levels of the blood ketone increased in the control group(T3,T5)and decreased in the trial group(T3,T5),and the differences were statistically significant(P<0.05).There was no significant difference between the control group and the trial group about the levels of blood lactate,BE,pH,blood electrolytes and the index of circulatory states(T1-T5).Conclusions:The stable infusion of a small dose(500mL)of sodium,potassium,magnesium,calcium and glucose injection during operation can reduce the formation of ketone body,however,the increase of blood glucose is obvious and therefore it is not suitable for routine infusion.

关 键 词：2型糖尿病 钠钾镁钙葡萄糖注射液 血糖 血酮 

分 类 号：R457.2[医药卫生—治疗学] R587.1[医药卫生—临床医学]