Li Chunxiu,Zhao Jialian,Tan Linhua.Analysis of risk factors related to hypoglycemia during neonatal surgery[J].Journal of Clinical Pediatric Surgery,2023,22(01):67-71.[doi:10.3760/cma.j.cn101785-202106055-013]
新生儿手术中低血糖的危险因素分析
- Title:
- Analysis of risk factors related to hypoglycemia during neonatal surgery
- Keywords:
- Hypoglycemia; Physiological Phenomena; Infant; Newborn; Surgical Procedures; Operative; Root Cause Analysis
- 摘要:
- 目的 分析新生儿手术中发生低血糖的危险因素。方法 回顾性分析2019年8月至2020年7月浙江大学医学院附属儿童医院实施的229例新生儿手术患者资料。将术中血糖低于2.2mmol/L者纳入低血糖组(19例),血糖高于或等于2.2mmol/L者纳入非低血糖组(210例)。收集两组患儿术前资料(包括年龄、体重、纠正胎龄、出生Apgar评分、血胆红素及白蛋白浓度、有无贫血及低蛋白血症、是否肠外营养以及产妇有无妊娠期糖尿病、妊娠高血压综合征等)和术中资料(包括麻醉ASA分级、手术时长、手术名称、术中血糖水平、术中输血量、输液量、失血量及体温情况)。分析新生儿手术中发生低血糖的危险因素。结果 低血糖组和非低血糖组患儿纠正胎龄分别为35(34,38)周和38(35,39)周;体重分别为(2.15±0.68)kg和(2.81±0.74)kg;1分钟Apgar评分分别为9(8,10)分和10(10,10)分;低蛋白血症发生率分别为36.84%(7/19)和11.90%(25/210);ASA分级分别为3(2,3)级和2(2,2)级;患儿术中输血率分别为42.11%(8/19)和19.52%(41/210);两组间上述结果比较,差异均有统计学意义(P均<0.05)。两组术前血糖水平及手术时长比较,差异均无统计学意义(P>0.05)。多因素分析结果提示,高ASA分级及低纠正胎龄是新生儿手术中发生低血糖的独立危险因素(P值分别为0.026、0.006)。结论 新生儿手术中低血糖的发生与高ASA分级和低纠正胎龄有关。
- Abstract:
- ObjectiveTo explore the intraoperative risk factors associated with neonatal hypoglycemia.MethodsFrom August 2019 to July 2020,a total of 229 neonatal surgical children were recruited.Based upon the level of neonatal intraoperative blood glucose,individuals below 2.2 mmol/L were assigned into hypoglycemia group (n=19) and those above or equal to 2.2 mmol/L into non-hypoglycemic group (n=210).The relevant clinical data of two groups were compared with regards to preoperative profiles (including age,body weight,corrected gestational age,postnatal Apgar score,gestational diabetes mellitus,pregnancy-induced hypertension,neonatal bilirubin concentration,albumin concentration,anemia,hypoproteinemia and parenteral nutrition) and intraoperative findings (including ASA grade,operative duration,operation approach,intraoperative blood glucose,intraoperative blood transfusion volume,infusion volume,blood loss volume,urine volume,dosing of vasoactive drugs and body temperature).ResultsThe corrected gestational age of hypoglycemic and non-hypoglycemic groups was[35(34,38) vs.38(35,39) week],body weight[(2.15±0.68) vs.(2.81±0.74) kg],1 min Apgar score[9(8,10) vs.10(10,10)],incidence of hypoproteinemia[36.84%(7/19) vs.11.90%(25/210)],ASA grade[3(2,3) vs.2(2,2)],intraoperative blood transfusion volume[42.11%(8/19) vs.19.52%(41/210)].The above results showed significant sinter-group tatistical differences (P<0.05).No significant inter-group difference existed in preoperative blood glucose level or operative duration (P>0.05).The results of multivariate analysis indicated that high ASA grade and low corrected gestational age were independent risk factors for neonatal hypoglycemia (P=0.026 and P=0.006).ConclusionOccurrence of intraoperative hypoglycemia in neonates is associated with high ASA grade and low corrected gestational age.
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备注/Memo
收稿日期:2021-06-20。
基金项目:国家儿童健康与疾病临床医学研究中心自主设计项目全国多中心临床研究项目(G20B0009)
通讯作者:谈林华,Email:chtlh@zju.edu.cn