Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
The Mountain-Whisper-Light Statistics LLC, Seattle, WA, USA.
Am J Surg. 2019 Aug;218(2):302-310. doi: 10.1016/j.amjsurg.2018.10.024. Epub 2018 Oct 16.
The relationship between acute phase perioperative hyperglycemia and postoperative outcome is poorly understood.
Retrospective cohort study of diabetic and non-diabetic adult patients undergoing non-cardiac surgery. Mean glucose and glycemic variability during the intraoperative and immediate postoperative periods were compared to length of stay, 30-day mortality, and postoperative complications.
. DIABETIC PATIENTS (N = 1096): Higher glycemic variability was associated with longer hospital length of stay (0.32 day per 10 mg/dL) and greater 30-day mortality risk (OR = 1.42). Higher mean glucose (OR = 1.07) and glycemic variability (OR = 1.11) were associated with higher risk of complications. NON-DIABETIC PATIENTS (N = 1012): Both higher mean glucose (0.29 day per 10 mg/dL) and higher glycemic variability (0.68 day per 10 mg/dL) were associated with longer hospital length of stay. Both higher mean glucose (OR = 1.13) and higher glycemic variability (OR = 1.21) were associated with greater risks of complications.
Poor acute phase perioperative glycemic control is associated with poor outcome, but differently in diabetic and non-diabetic patients suggesting different glycemic management strategies for the two patient groups.
急性围手术期高血糖与术后结局之间的关系尚未完全阐明。
回顾性分析了接受非心脏手术的糖尿病和非糖尿病成年患者的队列研究。术中及术后即刻血糖均值和血糖变异性与住院时间、30 天死亡率和术后并发症进行了比较。
糖尿病患者（n=1096）：血糖变异性越高，住院时间越长（每 10mg/dL 增加 0.32 天），30 天死亡率风险越高（OR=1.42）。血糖均值（OR=1.07）和血糖变异性（OR=1.11）越高，并发症风险越高。
非糖尿病患者（n=1012）：血糖均值越高（每 10mg/dL 增加 0.29 天）和血糖变异性越高（每 10mg/dL 增加 0.68 天），住院时间越长。血糖均值越高（OR=1.13）和血糖变异性越高（OR=1.21），并发症风险越高。
急性围手术期血糖控制不佳与不良结局相关，但在糖尿病和非糖尿病患者中表现不同，提示这两种患者人群应采用不同的血糖管理策略。
