葡萄糖-胰岛素-钾可缓解剖宫产术后子宫绞痛：一项随机对照试验。
Glucose-insulin-potassium alleviates uterine cramping pain following cesarean delivery: A randomized, controlled trial.
作者信息
Yang Guiying, Cui Yu, Bao Xiaohang, Wu Zhuoxi, Chen Qin, Chen Feng, Liu Wenjun, Wang Mingming, Luo Li, Li Hong
机构信息
Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China.
Department of Anesthesiology, the Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, China.
出版信息
Front Surg. 2023 Jan 9;9:1068993. doi: 10.3389/fsurg.2022.1068993. eCollection 2022.
OBJECTIVES
To explore the effect of glucose-insulin-potassium (GIK) therapy on uterine cramping pain (UCP) following cesarean delivery (CD).
DESIGN
Single-center, randomized controlled study.
SETTING
Second Affiliated Hospital of Army Medical University, Chongqing, China.
PARTICIPANTS
A total of 140 women, aged 20-40 years, who underwent CD with a transverse incision were randomly assigned to the GIK (P) or control (C) groups in a 1:1 ratio.
INTERVENTIONS
GIK was intravenously administered to patients in Group P. Patients in Group C received normal saline (NS). After umbilical cord clamping, oxytocin was administered intravenously. The same GIK and NS regimens were administered on postoperative days 1 and 2, followed by oxytocin 10 min later.
PRIMARY AND SECONDARY OUTCOME MEASURES
Following oxytocin administration, UCP was assessed using the visual analog scale (VAS), and the maximum VAS score (primary outcome) was recorded.
RESULTS
Patients in Group P had significantly lower maximum VAS scores than those in Group C on postoperative days 1 (38.4 ± 21.1 vs. 52.3 ± 20.8, < 0.001) and 2 (10 [0,30] vs. 30.5 [8.75,50], < 0.001). Group P patients also had shorter pain duration on postoperative day 1 (39.6 ± 19.5 min vs. 50.6 ± 18.2 min, = 0.001). Group P patients had a lower incidence of inadequate analgesia of UCP than Group C on days 1 (45.5% vs. 74.2%, < 0.001) and 2 (10.6% vs. 47.0%, < 0.001); the RRs for experiencing inadequate analgesia for UCP postpartum in Group P patients was 0.612 (95% CI: 0.454-0.826, < 0.001) on day 1 and 0.226 (95% CI: 0.107-0.476, < 0.001) on day 2. The absolute risk reduction (ARR) was 28.7%; thus number needed to treat (NNT) was 3 after rounding up. A subgroup analysis demonstrated that Group P patients undergoing repeat CD had lower maximum VAS scores for UCP on both postoperative days 1 and 2.
CONCLUSION
Our findings suggest that GIK can relieve UCP and shorten its duration. Our results provide information to facilitate the development of novel approaches for managing UCP. This study was approved by the Medical Ethics Committee of Second Affiliated Hospital of Army Medical University (2020-109-01, 19/11/2020) and registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2100041607,01/01/2021).
目的
探讨葡萄糖 - 胰岛素 - 钾（GIK）疗法对剖宫产术后子宫绞痛（UCP）的影响。
设计
单中心随机对照研究。
地点
中国重庆陆军军医大学第二附属医院。
参与者
总共140名年龄在20至40岁之间、行横向切口剖宫产的女性，按1:1比例随机分为GIK（P）组或对照组（C）。
干预措施
P组患者静脉输注GIK。C组患者输注生理盐水（NS）。脐带结扎后，静脉注射缩宫素。术后第1天和第2天给予相同的GIK和NS方案，10分钟后再给予缩宫素。
主要和次要观察指标
注射缩宫素后，使用视觉模拟量表（VAS）评估UCP，并记录最大VAS评分（主要指标）。
结果
P组患者术后第1天（38.4±21.1 vs. 52.3±20.8，<0.001）和第2天（10[0,30] vs. 30.5[8.75,50]，<0.001）的最大VAS评分显著低于C组。P组患者术后第1天的疼痛持续时间也较短（39.6±19.5分钟 vs. 50.6±18.2分钟，=0.001）。P组患者术后第1天（45.5% vs. 74.2%，<0.001）和第2天（10.6% vs. 47.0%，<0.001）UCP镇痛不足的发生率低于C组；P组患者产后UCP镇痛不足的相对危险度（RR）在第1天为0.612（95%CI：0.454 - 0.826，<0.001），第2天为0.226（95%CI：0.107 - 0.476，<0.001）。绝对风险降低（ARR）为28.7%；因此向上取整后的治疗所需人数（NNT）为3。亚组分析表明，接受再次剖宫产的P组患者术后第1天和第2天UCP的最大VAS评分较低。
结论
我们的研究结果表明，GIK可以缓解UCP并缩短其持续时间。我们的结果为开发管理UCP的新方法提供了信息。本研究经陆军军医大学第二附属医院医学伦理委员会批准（2020 - 109 - 01，2020年11月19日），并在中国临床试验注册中心注册（http://www.chictr.org.cn，ChiCTR2100041607，2021年1月1日）。
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