Filho Nazel Oliveira, Alves Rodrigo L, Fernandes Adriano T, Castro Fernanda S P, Melo José Roberto Tude, Módolo Norma S P
Departments of 1 Anesthesiology and.
Department of Anesthesiology, Hospital Universitário Professor Edgar Santos, Salvador, Bahia;
J Neurosurg Pediatr. 2016 May;17(5):625-9. doi: 10.3171/2015.9.PEDS1559. Epub 2016 Jan 1.
OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.
接受心脏手术的围手术期儿科患者以及头部创伤患者的血糖急性升高与术后并发症发生率较高相关。在文献中，关于接受择期神经外科手术患者高血糖的发生情况及其与不良结局的关联的数据较少。本研究旨在确定儿童中枢神经系统肿瘤切除术择期神经外科手术围手术期高血糖的发生是否与发病率增加相关。方法：这项回顾性队列分析纳入了2005年1月至2010年12月期间在巴西萨尔瓦多的三级医疗中心圣拉斐尔医院接受幕上和幕下中枢神经系统肿瘤切除术的105名12岁以下儿童。从病历中收集人口统计学数据以及术中及术后信息。采用非参数检验评估围手术期血糖水平的差异。结果：发生术后并发症的患者在重症监护病房（ICU）入院时血糖水平较高（162.0±35.8mg/dl对146.3±43.3mg/dl；p = 0.016），术后第1天血糖峰值水平也较高（171.9±30.2mg/dl对156.1±43.2mg/dl；p = 0.008）。多因素分析显示，术后第1天的血糖峰值水平与术后并发症的较高比值比独立相关（比值比1.05）。入住ICU时高血糖（>150mg/dl）的发生与ICU住院时间延长（p = 0.003）和住院时间延长（p = 0.001）相关。结论：儿童中枢神经系统肿瘤切除术择期神经外科手术后高血糖的发生与住院时间和ICU住院时间延长相关。术后并发症与入住ICU时较高的血糖水平以及术后第１天较高的血糖峰值相关。
