Sechterberger Marjolein K, Hermanides Jeroen, Poolman Rudolf W, Kal Jasper E, Meijers Joost C M, Hoekstra Joost B L, Hans DeVries J
Dept of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Dept of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
BBA Clin. 2015 Mar 11;3:227-32. doi: 10.1016/j.bbacli.2015.03.001. eCollection 2015 Jun.
Hyperglycaemia during and after hip surgery is associated with coagulation activation and an increased risk of venous thromboembolism. Whether lowering of glucose levels during hip surgery diminishes coagulation activation is unknown. We investigated the efficacy of the human GLP-1 analogue liraglutide to lower glucose during and after hip surgery and studied its influence on coagulation activation.
A total of 37 obese subjects who underwent hip surgery were randomized to subcutaneous liraglutide or placebo for 4 consecutive days, starting one day prior to surgery. Glucose levels and coagulation indices at three fixed time-points (pre-operative, 2 h post-operative and 3 days post-operative) were measured.
Liraglutide reduced glucose at day three post-surgery (median glucose (IQR) liraglutide 5.5 (5.2-5.7) vs. placebo 5.8 (5.5-6.2); difference 0.3 mmol/L, P = 0.04). Changes in 6 out of 8 coagulation indices studied did not differ between the two groups. Only D-dimer levels were significantly lower in the liraglutide group at day three post-surgery and FVIII levels were significantly higher in the liraglutide group 2 h post-surgery.
Although the human GLP-1 analogue liraglutide moderately reduced post-operative blood glucose levels in non-diabetic and prediabetic obese patients undergoing elective hip surgery, no changes were observed with respect to coagulation activation.
髋关节手术期间及术后的高血糖与凝血激活及静脉血栓栓塞风险增加有关。髋关节手术期间降低血糖水平是否能减少凝血激活尚不清楚。我们研究了人胰高血糖素样肽-1类似物利拉鲁肽在髋关节手术期间及术后降低血糖的疗效，并研究了其对凝血激活的影响。
共有37例接受髋关节手术的肥胖受试者被随机分为皮下注射利拉鲁肽组或安慰剂组，连续4天给药，从手术前一天开始。测量三个固定时间点（术前、术后2小时和术后3天）的血糖水平和凝血指标。
利拉鲁肽降低了术后第三天的血糖（利拉鲁肽组的血糖中位数（四分位间距）为5.5（5.2 - 5.7），安慰剂组为5.8（5.5 - 6.2）；差异为0.3 mmol/L，P = 0.04）。所研究的8项凝血指标中有6项在两组之间的变化没有差异。仅利拉鲁肽组在术后第三天的D - 二聚体水平显著较低，且在术后2小时利拉鲁肽组的FVIII水平显著较高。
尽管人胰高血糖素样肽-1类似物利拉鲁肽适度降低了接受择期髋关节手术的非糖尿病和糖尿病前期肥胖患者的术后血糖水平，但在凝血激活方面未观察到变化。
