择期剖宫产术中应用ERAS对GDM孕妇及其新生儿的疗效及安全性探讨  

Efficacy and Safety of Enhanced Recovery After Surgery for Pregnant Women with Gestational Diabetes Mellitus Undergoing Elective Cesarean Delivery and Their Newborns

作　　者：周瑾[1] 张培珍[1] 谭章敏 李婥 姚琳 何田田 尹玉竹[1] ZHOU Jin;ZHANG Peizhen;TAN Zhangmin;LI Chuo;YAO Lin;HE Tiantian;YIN Yuzhu(Department of Obstetrics and Gynecology,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院产科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2024年第6期930-940,共11页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨对择期剖宫产的妊娠期糖尿病(GDM)孕妇实施加速康复外科(ERAS)是否会导致孕妇围术期血糖异常以及增加新生儿低血糖的风险。【方法】回顾性分析2022年5月1日至2023年10月31日期间在中山大学附属第三医院行择期剖宫产并接受ERAS处理的单胎妊娠孕妇。其中血糖控制良好GDM孕妇纳入GDM组,以产妇年龄(18~30岁;30~35岁;35~40岁,>40岁),BMI(<18.5 kg/m^(2);18.5~24.9 kg/m^(2);25~30 kg/m^(2);>30 kg/m^(2))及胎龄(7 d内)为标准,1:1匹配非GDM产妇为对照组。观察术前口服碳水化合物后孕产妇血糖变化趋势、任何时段的高血糖、低血糖,以及新生儿低血糖、低Apgar评分、血气分析中异常PH值的发生率,分娩后即刻转儿科率。【结果】本研究共收集孕妇150例,其中GDM组(n=75),非GDM组(n=75),两组孕妇手术当日空腹血糖无明显差异[(4.4±0.5)mmol/L vs.(4.3±0.5)mmol/L;t=1.395,P=0.165],在饮用300 mL(含低剂量碳水化合物42.6 g)的清亮饮品后30 min达到血糖峰值[(7.2±0.9)mmol/L vs.(6.4±0.8)mmol/L;t=5.773,P<0.001],后快速下降,在口服碳水化合物后120 min时血糖基本回到口服碳水化合物前水平,GDM组血糖均显著高于非GDM组(P<0.005)。虽然在口服碳水化合物后30 min的血糖峰值中,GDM组孕妇的高血糖发生率显著高于非GDM组,差异有统计学意义(17.3%vs.1.3%,χ^(2)=11.354,P<0.001),但并未发生严重高血糖(≥10 mmol/L)。GDM组新生儿低血糖发生率与非GDM组相比差异无统计学意义(22.7%vs.28%,χ^(2)=0.564,P=0.453)。与非GDM组相比,在调整了年龄+BMI(Model 1);初产+分娩孕周(Model 2);妊娠期高血压疾病(Model 3);剖宫产指征+剖宫产时间+术中出血(Model 4);新生儿体质量(Model 5)后,ERAS并没有显著增加GDM组新生儿低血糖发生率。【结论】对血糖控制良好的GDM孕妇择期剖宫产前实施口服低剂量碳水化合物的ERAS方案不增加孕妇术前严重高血糖及新生儿低血糖的风险。【Objective】To explore if the enhanced recovery after surgery(ERAS)protocol for pregnant women with gestational diabetes mellitus(GDM)who are undergoing elective cesarean delivery could cause perioperative glycemic abnormalities and heighten the risk of neonatal hypoglycemia.【Methods】A retrospective analysis was conducted on a cohort of pregnant women with singleton pregnancies who underwent elective cesarean sections and received ERAS between May 1,2022,and October 31,2023,at the Third Affiliated Hospital of Sun Yat-sen University.A total of 150 patients were included in this study,comprising the GDM group(n=75)and the non-GDM group(n=75).The study included pregnant women with good glycemic control(GDM)and maternal age(18-30 years;30-35 years;35-40 years;>40 years),BMI(<18.5 kg/m^(2);18.5-24.9 kg/m^(2);25-30 kg/m^(2);>30 kg/m^(2)),and gestational age(within 7 days).We used these criteria to match 1:1 non-GDM women as the control group.After administering preoperative oral carbohydrates,we observed the trends of maternal glycemic changes,including hyperglycemia and hypoglycemia,at any time of the day.We also evaluated the incidence of hypoglycemic low Apgar scores in newborns,abnormal pH values in blood gases,and the rate of transfer to the pediatric unit immediately after delivery.【Results】No significant difference was observed in fasting blood glucose levels on the day of surgery between the two groups of pregnant women[(4.4±0.5)mmol/L vs.(4.3±0.5)mmol/L,t=1.395,P=0.165].The blood glucose peak was reached 30 minutes after consuming 300 mL(42.6 g of low-dose carbohydrate)of a light drink[(7.2±0.9)mmol/L vs.(6.4±0.8)mmol/L,t=5.773,P<0.001],with a subsequent decline in blood glucose levels.At the 120-minute mark,blood glucose had returned to the pre-oral carbohydrate level.The blood glucose levels in GDM groups was significantly higher than those in the non-GDM group(P<0.005).Although the incidence of hyperglycemia was significantly higher in the GDM group than in the non-GDM group at the 30-minute

关 键 词：加速康复外科 妊娠期糖尿病 择期剖宫产 术前碳水化合物饮料 新生儿低血糖 

分 类 号：R714[医药卫生—妇产科学]