Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Ann Surg. 2011 Apr;253(4):739-44. doi: 10.1097/SLA.0b013e31820b4bfc.
To investigate the relation between perioperative hyperglycemia and complications after pancreatoduodenectomy.
Perioperative hyperglycemia is associated with complications after various types of surgery. This relation was never investigated for pancreatoduodenectomy.
In a consecutive series of 330 patients undergoing pancreatoduodenectomy, glucose values were collected from the hospital information system during 3 periods: pre-, intra-, and early postoperative. The average glucose value per period was calculated for each patient and divided in duals according to the median group value. Odds ratios for complications were calculated for the upper versus lower dual, adjusted for age, sex, American Society of Anesthesiologists Classification, body mass index, diabetes mellitus, intraoperative blood transfusion, duration of surgery, intraoperative insulin administration, and octreotide use. The same procedures were carried out to assess the consequences of increased glucose variability, expressed by the standard deviation.
Average glucose values were 135 (preoperative), 133 (intraoperative) and 142 mg/dL (early postoperative). Pre- and intraoperative glucose values were not associated with postoperative complications. Early postoperative hyperglycemia (≥140 mg/dL) was significantly associated with complications [odds ratio (OR) 2.9, 95% confidence interval (CI), 1.7-4.9]. Overall, high glucose variability was not significantly associated with postoperative complications, but early postoperative patients who had both high glucose values and high variability had an OR for complications of 3.6 (95% CI, 1.9-6.8) compared to the lower glucose dual.
Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy. High glucose variability may enhance this risk. Future research must demonstrate whether strict glucose control in the early postoperative period prevents complications after pancreatoduodenectomy.
探讨胰十二指肠切除术后围手术期高血糖与并发症的关系。
围手术期高血糖与多种类型手术的并发症有关。但这种关系从未在胰十二指肠切除术患者中进行过研究。
在连续 330 例接受胰十二指肠切除术的患者中，从医院信息系统中收集了手术前、手术中和手术后早期的血糖值。为每位患者计算了每个时间段的平均血糖值，并根据中位数组值将其分为两组。对于并发症，上组与下组的比值比（OR）通过调整年龄、性别、美国麻醉医师协会分类、体重指数、糖尿病、术中输血、手术持续时间、术中胰岛素给药和奥曲肽使用等因素进行计算。为了评估血糖变异性增加的后果，采用标准差表示，也进行了相同的程序。
平均血糖值分别为 135（术前）、133（术中）和 142mg/dL（术后早期）。术前和术中血糖值与术后并发症无关。术后早期高血糖（≥140mg/dL）与并发症显著相关（OR 2.9，95%置信区间，1.7-4.9）。总体而言，高血糖变异性与术后并发症无显著相关性，但术后早期同时存在高血糖值和高变异性的患者，其并发症的 OR 为 3.6（95%置信区间，1.9-6.8），与较低的血糖组相比。
胰十二指肠切除术后早期高血糖与术后并发症有关。高血糖变异性可能增加这种风险。未来的研究必须证明术后早期严格控制血糖是否能预防胰十二指肠切除术后的并发症。
