非心脏手术中静脉注射胰岛素的术中血糖反应：DeLiT随机试验的亚组分析
The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial.
作者信息
Abdelmalak Basem B, Duncan Andra E, Bonilla Angela, Yang Dongsheng, Parra-Sanchez Ivan, Fergany Amr, Irefin Samuel A, Sessler Daniel I
机构信息
Associate Professor, Department of General Anesthesiology, Cleveland Clinic.
Assistant Professor, Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH, USA.
出版信息
J Clin Anesth. 2016 Mar;29:19-29. doi: 10.1016/j.jclinane.2015.10.005. Epub 2016 Feb 2.
Patient characteristics may affect patients' response to insulin. We examined the impact of body weight and presence of diabetes on the response to insulin during noncardiac surgery. We studied 202 patients who were enrolled in the DeLiT Trial and received intraoperative intravenous insulin. Univariable and multivariable analyses (Bonferroni corrected) assessed the relationship between patient's response to the initial intraoperative I.V. bolus of regular insulin and the factors of interest. Blood glucose concentrations decreased 8.3 ± 10mg/dL (0.46 ± 0.56mmol/L) per unit of I.V. insulin in 30minutes. The response to insulin was similar in patients with or without diabetes (adjusted mean difference [97.5% confidence interval], 0.2 [-3.9, 4.2] mg/dL, 0.01 [-0.22, 0.24] mmol/L; P = .93). No relationship was found between insulin response and body weight (P=0.38). Our results suggest that adjustment for body weight and the presence of diabetes may not improve intraoperative insulin treatment algorithms.
患者特征可能会影响患者对胰岛素的反应。我们研究了体重和糖尿病的存在对非心脏手术期间胰岛素反应的影响。我们研究了202名参与DeLiT试验并接受术中静脉注射胰岛素的患者。单变量和多变量分析（经Bonferroni校正）评估了患者对术中初始静脉推注普通胰岛素的反应与感兴趣因素之间的关系。每单位静脉注射胰岛素在30分钟内可使血糖浓度降低8.3±10mg/dL（0.46±0.56mmol/L）。糖尿病患者和非糖尿病患者对胰岛素的反应相似（校正后平均差异[97.5%置信区间]，0.2[-3.9,4.2]mg/dL，0.01[-0.22,0.24]mmol/L；P = 0.93）。未发现胰岛素反应与体重之间存在关联（P = 0.38）。我们的结果表明，根据体重和糖尿病的存在进行调整可能无法改善术中胰岛素治疗方案。
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