Hahn Robert G, Sjöstrand Fredrik
Karolinska Institutet at Danderyds Hospital (KIDS), Stockholm, Sweden.
Department of Clinical Research and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden.
Front Med (Lausanne). 2025 Jun 4;12:1577418. doi: 10.3389/fmed.2025.1577418. eCollection 2025.
The glucose-free crystalloid fluid used for intravenous infusion during surgery might be combined with or replaced by 2.5% glucose in debilitated patients. The aim of the present study was to use kinetic modeling to quantify the distribution of 2.5% glucose with balanced electrolytes administered during and after general anesthesia. The hypothesis was that awakening from anesthesia changes glucose and/or fluid volume kinetics in distinct ways.
A secondary analysis was performed based on data derived during and after intravenous administration of an isotonic mixture of 20 mL/kg of glucose 2.5% with electrolytes over 60 min in 12 non-diabetic adult patients undergoing laparoscopic cholecystectomy. Population glucose and volume kinetic analyses were performed based on blood and urine data collected for 4 h, which included 2 postoperative hours. Periods before and after awakening from anesthesia were contrasted using covariate analysis and further compared to 35 infusions in 17 awake volunteers who had received the same fluid at different rates and volumes.
The return flow of distributed fluid to the plasma was strongly retarded during and after anesthesia and promoted peripheral edema. Awakening decreased the rate of distribution, which counteracted the additional build-up of this edema but expanded the plasma volume. Urine output was strongly dependent on the mean arterial pressure; the urine flow rate at 75 mmHg was only 22% of the flow rate obtained at 90 mmHg. Simulations showed that the rate of administration of glucose 2.5% should be < 500 mL over 30 min to maintain plasma glucose < 10 mmol/L during surgery and postoperatively.
Awakening from general anesthesia inhibits the distribution of 2.5% glucose solution and accelerates the return of distributed fluid, with both responses increasing the plasma volume. These two effects counteract postoperative development of hypovolemia.
手术期间用于静脉输注的无糖晶体液在虚弱患者中可能会与2.5%葡萄糖混合使用或被其替代。本研究的目的是使用动力学模型来量化全身麻醉期间及之后给予的含平衡电解质的2.5%葡萄糖的分布情况。假设是麻醉苏醒会以不同方式改变葡萄糖和/或液体容量动力学。
基于12例接受腹腔镜胆囊切除术的非糖尿病成年患者在60分钟内静脉输注20 mL/kg含电解质的2.5%葡萄糖等渗混合物期间及之后获得的数据进行二次分析。根据收集4小时（包括术后2小时）的血液和尿液数据进行群体葡萄糖和容量动力学分析。使用协变量分析对比麻醉苏醒前后的时间段，并进一步与17名清醒志愿者以不同速率和容量接受相同液体的35次输注情况进行比较。
麻醉期间及之后，分布到组织间液的液体回流至血浆的过程受到强烈阻碍，并导致外周水肿。苏醒降低了分布速率，这抵消了水肿的进一步加重，但增加了血浆容量。尿量强烈依赖于平均动脉压；平均动脉压为75 mmHg时的尿流率仅为90 mmHg时获得的尿流率的22%。模拟结果表明，为在手术期间及术后维持血浆葡萄糖<10 mmol/L，2.5%葡萄糖的输注速率应在30分钟内<500 mL。
全身麻醉苏醒会抑制2.5%葡萄糖溶液的分布，并加速分布到组织间液的液体回流，这两种反应均会增加血浆容量。这两种效应可抵消术后低血容量的发生。
