脊髓麻醉下择期剖宫产术前口服碳水化合物负荷后母体和脐带血浆嘌呤浓度：一项随机对照试验
Maternal and umbilical cord plasma purine concentrations after oral carbohydrate loading prior to elective Cesarean delivery under spinal anesthesia: a randomized controlled trial.
作者信息
Kotfis Katarzyna, Jamioł-Milc Dominika, Wojciechowska Arleta, Szylińska Aleksandra, Drozd Arleta, Zimny Małgorzata, Dołęgowska Barbara, Kwiatkowski Sebastian, Dziedziejko Violetta, Safranow Krzysztof
机构信息
Department of Anesthesiology, Intensive Care and Pain Management, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
出版信息
BMC Pregnancy Childbirth. 2025 May 10;25(1):556. doi: 10.1186/s12884-025-07637-6.
OBJECTIVE
To evaluate the effect of preoperative intake of oral carbohydrates versus standard preoperative fasting prior to elective cesarean delivery on plasma purine levels (hypoxanthine, xanthine, and uric acid) and beta-hydroxybutyrate (β-HB) in mother's blood plasma and umbilical cord blood plasma.
METHODS
Prospective randomized clinical trial, performed according to the Declaration of Helsinki, IRB approval (KB-0012/113/19, 13.05.2019). Patients with at term gestation with singleton uncomplicated pregnancies, scheduled for cesarean delivery under spinal anaesthesia were randomized in a 1:1 ratio to Group I (oral carbohydrate drinks (CHO Group, oral carbohydrate drink - 200 mL - 12.5% dextrose in water) 2 h prior to surgery in addition to standard solid fasting (6 h) or Group II which underwent only standard fasting (6 h - solids, 2 h for - liquids, SF Group). Blood samples were collected at 2 h after carbohydrate consumption (maternal) and at umbilical cord clamping (umbilical cord). The primary outcomes - plasma concentrations of hypoxanthine, xanthine, uric acid, in maternal blood and umbilical cord blood were measured using high-performance liquid chromatography. The secondary outcomes were blood pH, and lactate, and butyrate concentration.
RESULTS
The study was conducted between August 2019, and March 2020 with 148 patients enrolled (75 CHO group; 73 SF group). Lower concentrations of hypoxanthine (3.87 (3.13-5.18) vs. 4.85 (3.88-6.53)µmol/l, p = 0.00050) and xanthine (0.79 (0.68-0.95) vs. 1.00 (0.88-1.22) µmol/l, < 0.00001) were observed in the maternal blood plasma and umbilical cord blood plasma (10.6 (8.00-16.5) vs. 13.9 (8.53-24.8) µmol/l, p = 0.035 and 1.05 (0.82-1.58) vs. 1.45 (0.94-3.17) µmol/l, p = 0.0035) in patients supplemented with carbohydrates. No difference in β-hydroxybutyrate concentration was noted.
CONCLUSIONS
Oral carbohydrate loading prior to cesarean delivery was associated with lower plasma purine levels in maternal and umbilical cord blood. Further work to understand the role of the purinergic pathway and ATP metabolism in maternal and neonatal health may guide interventions such as carbohydrate loading to optimize outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT04069806 (20190823).
目的
评估择期剖宫产术前口服碳水化合物与标准术前禁食对母亲血浆和脐带血血浆中嘌呤水平（次黄嘌呤、黄嘌呤和尿酸）及β-羟基丁酸（β-HB）的影响。
方法
前瞻性随机临床试验，按照《赫尔辛基宣言》进行，获得机构审查委员会批准（KB-0012/113/19，2019年5月13日）。足月单胎妊娠且无并发症、计划在脊髓麻醉下进行剖宫产的患者按1:1比例随机分为两组：第一组（口服碳水化合物饮料组，CHO组，口服碳水化合物饮料——200 mL——12.5%葡萄糖水溶液），术前2小时饮用，同时进行标准固体禁食（6小时）；第二组仅进行标准禁食（固体禁食6小时，液体禁食2小时，SF组）。在摄入碳水化合物2小时后（母亲）及脐带夹闭时（脐带）采集血样。主要结局指标——母亲血液和脐带血中次黄嘌呤、黄嘌呤、尿酸的血浆浓度，采用高效液相色谱法测定。次要结局指标为血液pH值、乳酸和丁酸浓度。
结果
研究于2019年8月至2020年3月进行，共纳入148例患者（CHO组75例；SF组73例）。补充碳水化合物的患者，其母亲血浆和脐带血血浆中次黄嘌呤浓度较低（3.87（3.13 - 5.18）μmol/l 对比 4.85（3.88 - 6.53）μmol/l，p = 0.00050），黄嘌呤浓度较低（0.79（0.68 - 0.95）μmol/l 对比 1.00（0.88 - 1.22）μmol/l，< 0.00001），尿酸浓度也较低（10.6（8.00 - 16.5）μmol/l 对比 13.9（8.53 - 24.8）μmol/l，p = 0.035；1.05（0.82 - 1.58）μmol/l 对比 1.45（0.94 - 3.17）μmol/l，p = 0.0035）。β-羟基丁酸浓度无差异。
结论
剖宫产术前口服碳水化合物负荷与母亲和脐带血中较低的血浆嘌呤水平相关。进一步研究以了解嘌呤能途径和ATP代谢在母亲和新生儿健康中的作用，可能会指导诸如碳水化合物负荷等干预措施以优化结局。
试验注册
ClinicalTrials.gov标识符NCT04069806（20190823）
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