| Objective:To observe the effect of multiple electrolytic and invert sugar injection on blood glucose,insulin, C peptide, BE, free fatty acids in patients undergoing operation of neurosurgery. Evaluate its effect on energy metabolism in these patients. Provide experience to clinical application through Application of invert sugar injection during operation.Methods:Sixty patients, aged20to60years old, weighing50-70kg, BMI:18.5kg/m2-24.9kg/m2, ASA Ⅰ-Ⅱ, anesthesia time>6hours undergoing elective craniotomy were randomly divided into three groups:IS(invert sugar)group, GS(glucose) group, NS(normal saline)group(n=20).These patients electrolyte,cardiopulmonary function and function of liver and kidney were normal, without diabetes and other metabolic disease history, no gout and hereditary fructose intolerance history. The patients were treated with total intravenous anesthesia, no premedication, preoperative fasting period does not use any sugary liquid. The patients’vital signs were monitored such as noninvasive blood pressure (NIBP), heart rate (HR), electrocardiogram (ECG), oxygen saturation (SpO2), the depth of anesthesia (BIS) in operating room. After open vein liquid road, the anesthesia was induced with intravenous injection of atropine0.5mg, midazolam0.05-0.1mg/kg,0.3-0.4μg/kg sufentanil,1.5-2mg/kg cisatracurium,1-1.5mg/kg propofol. The patients underwent tracheal intubation and mechanical ventilation.Tidal volume is set to8-10ml/kg, respiratory frequency is10-12times/min.By adjusting the respiratory parameters make the PETCO2were maintained at35-45mmHg.The patients were underwent right femoral vein puncture, dorsalis pedis artery puncture of invasive arterial blood pressure monitoring. Maintenance of anesthesia with propofol2-6mg/(kg·h), remifentanil0.10.3μg/(kg·min), Intermittent additional CIS atracurium.After the cycle stability, GS, IS, NS groups were given Sodium Chloride and Dextrose Injection500ml,5%Multiple Electrolytic and Invert Sugar Injection500ml and500ml physiological saline in one hour, then no longer give any sugary liquid. Blood glucose, blood insulin, C peptide, free fatty acid concentrations and BE value were measured at the0hours before the corresponding fluid infusion, infusion of250ml, infusion after0hour,1hours,3hours.If the measured blood glucose concentration>10mmol/L, then we need in the liquid adding insulin3units. The patients’ gender, age, weight, BMI and blood pressure, heart rate, BIS immediately at drawing blood were recorded. Bleeding and infusion with liquid in operation were amounted. The number and percentage of patients who get additional insulin was amounted.Results:Group IS compared with group NS, at T1, T2, T3the blood glucose was significantly elevated, at T1, T2, T3, T4insulin and C peptide was significantly increased, at T1, T2, T3and BE value was significantly decreased (P<0.05).There was no significant difference of free fatty acid in each point (P>0.05).IS group compared with GS group at T1, T2, T3the blood glucose was significantly less than it, at T1, T2the blood insulin and C-P was significant low(P<0.05).There was no significant difference of free fatty acid and BE value in each point (P>0.05). The number of people and percentage additional insulin at blood glucose>10mmol/L GS group was significantly more than IS group(P<0.05).Conclusions:Infusing5%Multiple Electrolytic and Invert Sugar Injection will cause the blood glucose, insulin, C peptide level significantly increase, this change is small compared with5%Glucose Injection. In the process of using invert sugar injection we need monitor the blood,control the infusion speed to avoid causing a transient increase in blood glucose. For preoperative metabolism in normal adult patients without intraoperative infusion fluid containing sugar, its energy metabolism is not significantly affected. |
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