Department of Anaesthesiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China.
Department of Clinical Epidemiology, Obstetrics & Gynaecology Hospital, Fudan University, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Jun 28;13:910914. doi: 10.3389/fendo.2022.910914. eCollection 2022.
Women with Gestational diabetes mellitus (GDM) had a higher need and consumption of analgesics than women without GDM. The preoperative level of HbA1c was associated with the postoperative consumption for analgesics in diabetic patients. This prospective observational study go further to investigate the relationship between the pre-operative HbA1c and the post-operative consumption for analgesics in women with GDM.
Women with GDM and a singleton pregnancy undergoing elective cesarean section under combined spinal-epidural anaesthesia were divided into two groups based on pre-operative HbA1c: group HbA1c < 6% and group HbA1c ≥ 6%. Analgesics consumption, number of patient-controlled analgesia (PCA) compression, and pain scores in 6 hours and 24 hours post-operation were compared between the two groups. Then Pearson's correlation coefficient and a stepwise multivariate linear regression were performed to investigate possible independentpredictors of post-operative 24-hour sufentanil consumption.
Analgesics consumption was significantly lower (18.8 ± 0.4 vs 23.2 ± 4.3; 82.7 ± 2.4 vs 115.8 ± 17.4, P < 0.001), and number of PCA compressions was significantly less frequent (1 [1-2] vs 3 [1-5]; 5 [3-7] vs 7 [3-15], P < 0.001), and in group HbA1c < 6% than in group HbA1c ≥ 6% in 6 hours and 24 hours post-operation.The univariate analysis showed that sufentanil consumption at 24 hours post-operation was significantly related to pre-operative HbA1c (r = 0.338, P < 0.001) and parity (r = 0.184, P = 0.03) and was related to blood glucose management methods (r = 0.172, P = 0.043). Multivariate linear regression analysis showed that HbA1c was the independent factor related to post-operative 24-hour sufentanil consumption (adjusted r2 = 0.246, P < 0.001).
This study demonstrated that in pregnant women with GDM, the pre-operative HbA1c is independently related to the need for and consumption of analgesics in 24 hours after CS.
患有妊娠期糖尿病（GDM）的女性比没有 GDM 的女性需要和消耗更多的镇痛药。糖尿病患者的术前糖化血红蛋白（HbA1c）水平与术后镇痛药的消耗有关。这项前瞻性观察研究进一步探讨了 GDM 妇女术前 HbA1c 与术后镇痛药消耗之间的关系。
根据术前 HbA1c 将接受择期剖宫产术的 GDM 单胎妊娠妇女分为两组：HbA1c＜6%组和 HbA1c≥6%组。比较两组术后 6 小时和 24 小时的镇痛药消耗、患者自控镇痛（PCA）按压次数和疼痛评分。然后进行 Pearson 相关系数和逐步多元线性回归分析，以探讨术后 24 小时舒芬太尼消耗的可能独立预测因素。
术后 6 小时和 24 小时，HbA1c＜6%组的镇痛药消耗明显低于 HbA1c≥6%组（18.8±0.4 比 23.2±4.3；82.7±2.4 比 115.8±17.4，P＜0.001），PCA 按压次数也明显减少（1[1-2] 比 3[1-5]；5[3-7] 比 7[3-15]，P＜0.001）。单变量分析显示，术后 24 小时舒芬太尼消耗量与术前 HbA1c（r=0.338，P＜0.001）和产次（r=0.184，P=0.03）显著相关，与血糖管理方法（r=0.172，P=0.043）相关。多元线性回归分析显示，HbA1c 是与术后 24 小时舒芬太尼消耗相关的独立因素（调整 r2=0.246，P＜0.001）。
本研究表明，在患有 GDM 的孕妇中，术前 HbA1c 与 CS 后 24 小时内对镇痛药的需求和消耗独立相关。
