Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Anesthesiology, Huai'an Fourth People's Hospital, Huai'an, Jiangsu, China.
J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2303-2310. doi: 10.1053/j.jvca.2020.10.061. Epub 2020 Nov 5.
The present study was performed to investigate the possible association between intercostal nerve block (INB) and postoperative glycemic control in patients with diabetes undergoing video-assisted thoracoscopic pulmonary resection.
A retrospective study.
Single-center tertiary academic hospital.
Patients with diabetes, ages 18 to 79 years, who had undergone elective video-assisted thoracoscopic pulmonary resection (segmentectomy or lobectomy) from January 1, 2015, to December 31, 2018.
Postoperative blood glucose levels and insulin dosage were extracted from the record.
Patients with diabetes who received INB before closure of surgical incisions were compared with those who did not receive INB. The primary outcome was the daily blood glucose (BG) level. Univariate analyses and multivariate regression analysis were performed to explore risk factors of hyperglycemia within 48 hours after the surgery. Baseline characteristics were comparable between the two groups. Patients who received INB had a lower maximum BG level and amplitude of glycemic excursion from zero-to-24 hours after surgery (p = 0.007 and p = 0.041, respectively) and lower maximum and minimum BG levels from 24-to-48 hours after surgery (p = 0.023 and p = 0.006, respectively). Meanwhile, the daily insulin dose increment during zero-to-24 hours and 24-to-48 hours after surgery decreased (p = 0.010 and p = 0.003, respectively), the white blood cell counts within 48 hours after surgery were lower (p = 0.021), and the length of postoperative stay decreased in the INB group (p = 0.044). Multivariate regression analysis further confirmed that INB was an independent protective factor of postoperative hyperglycemia (Nagelkerke R value 0.229; odds ratio 0.298; 95% confidence interval 0.099-0.901; p = 0.032).
INB, performed before closure of surgical incisions, was associated with improved glycemic control in patients with diabetes within 48 hours after video-assisted thoracoscopic pulmonary resection.
本研究旨在探讨肋间神经阻滞（INB）与糖尿病患者行电视辅助胸腔镜肺切除术后血糖控制之间的可能关联。
回顾性研究。
单中心三级学术医院。
年龄在 18 至 79 岁之间，2015 年 1 月 1 日至 2018 年 12 月 31 日期间行择期电视辅助胸腔镜肺切除术（肺段切除术或肺叶切除术）的糖尿病患者。
从病历中提取术后血糖水平和胰岛素剂量。
比较了在缝合切口前接受 INB 的糖尿病患者与未接受 INB 的患者。主要结局是每日血糖（BG）水平。进行了单因素分析和多变量回归分析，以探讨术后 48 小时内发生高血糖的危险因素。两组的基线特征无差异。接受 INB 的患者术后 0 至 24 小时的最高 BG 水平和血糖波动幅度（p=0.007 和 p=0.041）以及术后 24 至 48 小时的最高和最低 BG 水平均较低（p=0.023 和 p=0.006）。同时，术后 0 至 24 小时和 24 至 48 小时的每日胰岛素剂量增加量减少（p=0.010 和 p=0.003），术后 48 小时内的白细胞计数较低（p=0.021），并且 INB 组的术后住院时间缩短（p=0.044）。多变量回归分析进一步证实，INB 是术后高血糖的独立保护因素（Nagelkerke R 值 0.229；比值比 0.298；95%置信区间 0.099-0.901；p=0.032）。
在缝合切口前进行 INB 与电视辅助胸腔镜肺切除术后 48 小时内糖尿病患者的血糖控制改善相关。
