제왕절개술시 수액이 제대혈의 혈당, 전해질 및 인슐린에 미치는 영향

Abstract

It is well documented that rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. The maternal effect of hyperglycemia caused by rapid administration of dextrose solution may affect the fetus or the newborn baby as well. Therefore, there was a need to ascertain an appropriate IV solution for prehydration in cesarean section. The aim of this study was to determine an appropriate solution for cesarean section based on the results of the effects of matemal IV glucose solution on the newborn's glucose, electrolyte and insulin. 40 parturients scheduled for cesarem section were chosen at random. They were divided into two groups : one group received Hartmann's solution and the other group received 5% D/W. Patients' venous blood was drawn on the operating table prior to starting IV infusion for the measurement of blood sugar and electrolytes(Na, K, Cl) in various conditions of NPO. Then, intra-venous fluid was administered rapidly for prehydration about 20 ml/kg/hr(about 500 ml for 20 minutes) while anesthesia was induced and maintained with an endotracheal tube in place. The second blood samples were taken from matemal vein, umbilical vein and artery immediately after delivery for the measurement of glucose and electrolyte. At the same time insulin levels of umbilical veins were measured. The prehydrative glucose levels were 75.40+/-20.80 mg/dl in group 1 and 78.60+/-12.44 mg/dl in group 2. Both values were within normal range without significant hypoglycemia following the various times of NPO. Posthydration values of maternal glucose in group 2 with glucose infusion was 221.30+/-3.62 mg/dl. This was significantly higher than 72.20+/-7.11 mg/dl in group 1(p<0.05). At the time of delivery, the values of umbilical venous and arterial blood glucose in group 2 were significantly higher than in group 1(p<0.05). The values of insulin in umbilical venous blood in group 2 was 48.09+/-25.54 uU/ml. This was significantly higher than 6.06+/-2.06 uU/ml in group 1(p<0.05). Hydration using either solutions did not affect the value of electrolyte either in the mother or newborn baby. However, the rapid administration of glucose solution increased the maternal and umbilical glucoses as well as umbilical insulin proportionally. As the result of this study, prehydration with the solution containing glucose for cesarean section increased maternal and fetal glucoses as well as fetal insulin levels. Therefore, prehydration with any solution containing glucose is not recommended to prevent maternal and fetal hyperglycemia, and can result in delayed newbom hypoglycemia. It was concluded that prehydration with balanced electrolyte solution without dextrose seems to be safer to babies as well as mothers. Key Words ： Cesarean section, Glucose, Electrolyte, Insulin.

제왕절개술이 계획된 40명의 산모를 대상으로 제 1군은 균형전해질용액을, 제2군은 5% D/W용액을 분만전에 투여하여 수액 투여전과 투여후의 산모 혈 당과 전해질치 그리고 분만시 태아 제대 혈당, 전해 질 및 제대 정맥혈의 인술린치를 각각 비교하여 다음의 결론을 얻었다. 수액 투여전 산모의 혈당치는 제1군에서는 75.40 ±20.80 mg/dl, 제2군에서는 78.60±12.44 mg/dl로 양 군 사이에 차이가 없었으며 양군 모두 혈당의 정도는 정상범위내였다. 그리고 수액 투여전 산모의 전해 질치도 양군 모두 유사하였고 정상범위내였다. 수액 투여후 산모의 혈당치는 저U군의 72.20士7.11 mg/dl와 비교하여 제2군에서 221.30 ±3.62 mg./dl로 현저하게 증가하였다(p<0.05). 분만시 제대 동맥혈과 제대 정맥혈의 혈당치는 제 1군의 47.60土&64 mg/dl, 60.20±13.84 mg/dl보다 제 ‘2군에서 119.10±14.35 mg/dl, 130.30± 48.76 mg/dl로 의의있게 높았으며(p<0.05) 산모의 혈당치와 비례적인 관계가 있었다. 분만시 세대 정맥혈의 인술린치는 제1군의 6.60土 2.60 /AJ/ml와 비교하여 제2군에 48.09 ±25.54 pU./'ml 로 의의있게 높았다(p<0.05). 수액 투여전과 투여후 그리고 분만시 제대혈의 전해질치는 양군사이에 통계학적 유의성이 없었고, 제 2군에서 수액투여후 전해질이 다소 감소하는 경향을 보였다. 이상의 결과로 보아 산모에게 포도당이 함유된 용액을 과량 투여하면 산모의 과혈당증을 초래함과 동 시에 태아 혹은 신생아의 과혈당이 동반되어 태아 혹은 신생아의 인슐린의 분비를 촉진하여 신생아에 게 지연성 저혈당증을 유발할 수 있다. 따라서 산모를 수술하기 위하여 사전수액이 필요할 때는 포도당 이 함유되지 않은 균형전해질용액을 사용함이 바람직하다고 생각된다.