Coan Kathryn E, Schlinkert Andrew B, Beck Brandon R, Haakinson Danielle J, Castro Janna C, Schlinkert Richard T, Cook Curtiss B
Department of General Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
J Diabetes Sci Technol. 2013 Jul 1;7(4):983-9. doi: 10.1177/193229681300700421.
The objective was to assess processes of care for patients with diabetes undergoing elective surgery.
A retrospective review of medical records was conducted to determine frequency of perioperative glucose monitoring, changes in glucose control, and treatment of intraoperative hyperglycemia.
A total of 268 patients underwent 287 elective procedures. Mean age was 67 years, 63% were men, 97% had type 2 diabetes, and most (57%) were treated with oral hypoglycemic agents. Average perioperative time was approximately 8 h. Mean preoperative hemoglobin A1c was 7.0%; however, this value was checked in only 52% of cases. A glucose measurement was obtained in 89% of cases in the preoperative area and in 87% in the postanesthesia care unit, but in only 33% of cases did a value get checked intraoperatively. Average glucose was 139 mg/dl preoperatively, increasing to 166 mg/dl postoperatively (p <.001). Glucose levels increased regardless of type of outpatient medical therapy used to treat hyperglycemia, except for those on combination oral agents plus insulin (p =.06).
These data indicate suboptimal documentation of outpatient hemoglobin A1c. Intraoperative glucose monitoring seldom occurred, despite prolonged periods under anesthesia and perioperative deterioration of glycemic control. Standards need to be developed and interventions are needed to enhance management of diabetes patients undergoing elective procedures.
评估接受择期手术的糖尿病患者的护理过程。
对病历进行回顾性研究，以确定围手术期血糖监测的频率、血糖控制的变化以及术中高血糖的治疗情况。
共有268例患者接受了287例择期手术。平均年龄为67岁，63%为男性，97%患有2型糖尿病，大多数（57%）接受口服降糖药治疗。围手术期平均时间约为8小时。术前平均糖化血红蛋白为7.0%；然而，仅在52%的病例中检查了该值。术前区域89%的病例进行了血糖测量，麻醉后护理单元为87%，但术中仅33%的病例检查了血糖值。术前平均血糖为139mg/dl，术后升至166mg/dl（p<.001）。无论用于治疗高血糖的门诊药物治疗类型如何，血糖水平都会升高，但联合使用口服药物加胰岛素的患者除外（p = 0.06）。
这些数据表明门诊糖化血红蛋白的记录不充分。尽管麻醉时间延长且围手术期血糖控制恶化，但术中很少进行血糖监测。需要制定标准并采取干预措施，以加强对接受择期手术的糖尿病患者的管理。
