| ObjectiveWith the improvement of the living standard of our country and the change of life style,the incidence of type 2 diabetes is increasing.The increasing number of people with diabetes and the attention to prenatal and obstetric examination,the incidence of gestational diabetes mellitus(gestational diabetes mellitus GDM)is significantly higher.The main reason may be the presence of hyperinsulinemia in the early pregnancy.In the middle and late stages,the fetus continues to mature,the secretion of placental hormone increases,placental prolactin and progesterone have the resistance to insulin,and the sensitivity of the maternal peripheral tissue to insulin is gradually reduced.If the maternal insulin secretion is insufficient,it can not compensate for the insulin resistance caused by the above hormones,which may cause the insulin resistance.Abnormality of glucose tolerance and even the occurrence of diabetes.may be higher.At the same time,China’s family planning policy has been adjusted in 2013 and 2015,making the number of pluripara and advanced agepuerperant increasing rapidly.In the common influence of various factors,the number of pregnant women in gestational diabetes is more and more.Gestational diabetes tends to lead to hypertension of pregnancy,severe infection,fetal distress,premature birth,fetal macrosomia,placental malfunction,malposition,low blood calcium,hypoglycemia and uterine inertia,which will lead to a higher rate of caesarean section than ordinary parturient.The spinal block as a commonly used class of obstetric anesthesia program,has been widely used in cesarean section,not only can play a satisfactory analgesic effect,also can better ensure the safety of mother and child.In recent years,there are more and more reports of nerve injury after spinal block,which may be related to the increased sensitivity of the local nervous system to the local anesthetic in pregnancy.At the same time,in the study of diabetes,it is suggested that pre production hyperglycemia can increase nerve sensitivity and lead to postpartum nerve injury,and the risk of nerve injury after intraspinal block in pregnant women with gestational diabetes may be higher.This study will further understand the occurrence of nerve injury after intraspinal block of parturients,and observe the incidence of nerve injury after intraspinal block in pregnant women with gestational diabetes and normal blood glucose,and summarize the factors affecting the nerve injury after intraspinal block and the prevention of the incidence of nerve injury.To explore the rational anesthetic plan for pregnant women with gestational diabetes mellitus and improve the quality of obstetric anesthesia.MethodsThere were 5018 cases of maternal hospitalization in our hospital from January 2015 to December 2015.According to the inclusion and exclusion criteria,2206 cases requiring cesarean section were enrolled in the study.According to the prenatal history and blood glucose test during pregnancy,there were 453 cases of gestational diabetes and 1753 cases of normal blood sugar.Intraspinal block was used in the two groups of parturients,and the general data,physiological index,anesthesia index and fetal index were recorded.The incidence,duration,type and severity of the parturients were observed after anesthesia.Record the course of diabetes,blood sugar,diabetic complications,clinical diagnosis and treatment of gestational diabetes,and analyze the related risk factors for the occurrence of nerve injury in pregnant women with gestational diabetes(questionnaire).Objective To observe the incidence of nerve injury after maternal intraspinal block in women with gestational diabetes mellitus under different exposure factors,and to formulate reasonable anesthesia plan for pregnant women with gestational diabetes mellitus.Results1.The general data of height、age and anaesthesia among the groups were found to have no statistical difference,and the incidence of largefetus in the group of pregnant women with gestational diabetes was 9.93%and 2.80%(49/1753)in the normal blood glucose group,The difference between groups was statistically significant.(P<0.05).2.The incidence of nerve injury in pregnant women with gestational diabetes was 5.1%,and the incidence of nerve injury in normal blood sugar parturients was 1.5%.The incidence of nerve injury among the two groups was statistically significant(P<0.05).The Logistic regression analysis found that the main factors affecting the nerve injury of pregnant women with gestational diabetes were pregnancy hydroncus and anaesthesia paresthesia、the effect of blood sugar control.3.The incidence of nerve injury in the process of anesthesia puncture smooth going(two times)was 3.6%.The incidence of nerve injury was 14.5%.The incidence of nerve injury in the anesthesiapuncture smooth going was significantly lower than that of the anesthesiaprocess exception(P<0.05).4.The incidence of nerve injury induced by bupivacaine in pregnant women with gestational diabetes was 5%.The incidence of nerve injury in parturients with ropivacaine was 5.2%.There was no significant difference in the incidence of nerve injury in parturients with different narcotic drugs(P>0.05).5.The recovery and treatment of nerve injury,there were 49 cases of total nerve injury,three types of nerve injury,41 cases transient neurological syndrome,7 casesdelayed sacral sensory disturbance and 1 cases cauda equinea syndrome.24 cases were relieved 48 hours after operation,16 cases recovered within 1 weeks,2 cases recovered after one month’s visit,6 cases recovered after two months follow-up,1 cases recovered after three months.7 cases were discharged fromhypothyroidism in the partof the lower extremities,the recovery time was 10 days to 2 months,and 1 cases still had bladder smooth muscle paralysis,no micturition desire,improvement after 3 months the follow-up,no significant sequelae.early stage,used of hormone and dehydration treatment,neurotrophic drugs,such as two weeks after treatment,are mainly neurotrophic drugs,physiotherapy of traditional Chinese Medicine,acupuncture and moxibustion.Conclusion1.among the observation subjects,the incidence of macrosomia in gestational diabetes mellitus was higher than blood sugar pregnant women.2.the incidence of nerve injury in pregnant women with gestational diabetes was 5.1%,and the incidence of nerve injury in normal blood glucose group was 1.5%.Age,weight,height,gestational week,pregnancy,nerve block time,number of pregnanciesand,gestational hypertension did not increase the incidence of nerve injury.3.The risk factors of nerve injury in pregnant women with gestational diabetes are compared with those of normal blood sugar parturient.Besides the common influence factors hydroncus and anaesthesia paresthesia,the effect of blood glucose control is closely related to the occurrence of nerve injury.4.There was no significant difference in the incidence of nerve injury between bupivacaine and ropivacaine in pregnant women with gestational diabetes mellitus.5.there were 49 cases of nerve injury,41 cases of TNS,7 of delayed sacral nerve sensory disturbance,1 cases of mild CES,and 3 months of recovery without serious sequelae. |
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