| Objective: To investigate the effect of intravenous glucose infusion on the incidence and severity of postoperative nausea and vomiting(PONV).Methods: This study was designed as a prospective cohort study.A total of 128 patients,ASA grade I to II,aged 30 to 65 years old,who planned to undergo elective gynecological laparoscopic surgery in Affiliated Hospital of Inner Mongolia Medical University from December 2021 to December 2022 were recruited.Random number table method was used to divide the glucose solution infusion group(G group,n=64)and lactate Ringer’s solution infusion group(L group,n=64).After endotracheal intubation,group G was given intravenous infusion of Ringer lactate 1.5m L/kg/h(fasting duration)+10% glucose solution 0.5g/kg;Group L was intravenously infused with Ringer lactate 1.5m L/kg/h(fasting duration)at a rate of 10 m L/kg/h,respectively.Glucose oxidase method and enzyme-linked immunosorbent assay were used to detect blood glucose and insulin levels before,after and 24 h after surgery.Homeostasis model assessment(HOMA)was used to calculate Homeostasis model assessment-insulin resistance(HOMA-IR).The main postoperative follow-up indexes included: occurrence and severity of nausea and vomiting 24 h after surgery.Secondary follow-up indexes included opioid drug use,postoperative analgesia evaluation,frequency of administration of remedial antiemetic and analgesic drugs,postoperative gastrointestinal function recovery time and postoperative hospital stay.Results: There were no significant differences in age,height,weight,Body Mass Index(BMI),PONV history,ASA grading,duration of anesthesia and operation,and intraoperative fluid volume between the two groups(P > 0.05).The incidence of PONV 24 h after surgery in group G and group L was 42.9%(24/56)and 63%(34/54),respectively.The incidence of PONV 24 h after surgery in group G was lower than that in group L,and the difference between groups was statistically significant(P < 0.05).Compared with group L,the severity of PONV in group G was decreased(P < 0.05),and no cases above grade Ⅳ were observed in both groups.Compared with group L,the incidence of PONV in group G was lower at 0～30min and 30 min to 2h after surgery(P < 0.05).There was no significant difference in the incidence of PONV at 2～6h,6～12h and 12～24h after surgery(P > 0.05).There were no significant differences in opioid consumption,postoperative analgesia evaluation,remedial antiemesis and analgesia,gastrointestinal function recovery time and postoperative length of hospital stay between the two groups(P > 0.05).The patients were divided into PONV group and non-PONV group according to whether nausea and vomiting occurred 24 hours after operation.There were no significant differences in preoperative blood glucose,insulin and insulin resistance index between the two groups(P > 0.05).Compared with non-PONV group,blood glucose,insulin and insulin resistance index were increased in PONV group after surgery(P < 0.05).There was no difference in blood glucose 24 h after surgery between the two groups,and insulin and insulin resistance index were increased in PONV group 24 h after surgery(P < 0.05).Pearson correlation analysis showed that there was a correlation between blood glucose concentration and insulin resistance(P < 0.05),Spearman correlation analysis showed that there was a weak positive correlation between early PONV severity grade and blood glucose after surgery(P <0.05),but no correlation between them 24 h after surgery(P > 0.05).PONV severity grade was positively correlated with insulin resistance index after surgery and 24 h after surgery(P <0.05).Univariate results showed significant differences in age(P < 0.001),PONV history(P= 0.002),and postoperative insulin resistance(P < 0.001)between gynecological laparoscopic patients with and without PONV.Multivariate Logistic regression analysis was performed for risk factors with statistical differences,and the results showed age(95%CI 0.342 ～ 0.684,P <0.001),PONV history(95%CI 1.934 ～ 166.854,P = 0.011)and insulin resistance after surgery(95%CI 1.018 ～ 2.068,P = 0.040)were independent risk factors for PONV in gynecological laparoscopic surgery.Conclusion: Intravenous glucose infusion may reduce the incidence and severity of PONV after gynecological laparoscopic surgery by reducing insulin resistance... |
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