Qing A L, Lei X H, Chen L, Sun F G, Weng Y, Li C Y, Ye L, Wen C B
Department of Pain Medicine,West China Hospital, Sichuan University,Chengdu 610041, China.
West China School of Public Health, Department of Anesthesiology, West China Fourth Hospital,Sichuan University,Chengdu 610041, China.
Zhonghua Yi Xue Za Zhi. 2021 Nov 23;101(43):3554-3558. doi: 10.3760/cma.j.cn112137-20210726-01663.
To investigate the effects of different doses of glucocorticoids on minimally invasive procedures in patients with type 2 diabetes mellitus (T2DM), and optimize the clinical pathways of minimally invasive procedures. The clinical data of 284 patients with T2DM who received minially invasive procedures from the Department of Pain Medicine, West China Hospital, Sichuan University from May 2017 to May 2020 were retrospectively reviewed. The patients were divided into two groups according to the main diagnostic types: spine-related group (=148) and herpes zoster group (=136). According to the cumulative dose of glucocorticoids (GCs) per unit body surface area during the hospitalization, patients were further divided into three subgroups: low-dose group (GCs<3.5 mg/m), medium-dose group (3.5 mg/m ≤GCs<7 mg/m), and high-dose group (GCs≥7 mg/m). The clinical characteristics of the patients in different subgroups of the two diseases groups were compared. The effects of the glucocorticoids on the pain intensity, blood glucose, length of hospital stay (LOS) and total hospitalization cost were compared among the 3 subgroups of the two diseases groups. There were no significant differences in the age, gender, height, weight, visual analog scale (VAS) and fasting blood glucose before procedures between the two groups (all >0.05). The VAS score of the low-dose group from the spine-related group was 4.5±1.6, which was higher than that of the medium-dose group (3.5±1.3) (=0.004). VAS score was 4.3±1.3 in the medium-dose group and 4.4±1.6 in the high-dose group from the herpes zoster group, which were higher than that in the low-dose group (3.5±0.9) (=0.006). In terms of blood glucose, the impact on the fasting blood glucose before and after the procedures in the low-dose group from the spine-related group was less than that in the medium dose group (=0.013). In the herpes zoster group, the blood glucose of the low-dose group was (11±5) mmol/L, which had less influence on the blood glucose fluctuation during the hospitalization than that in the high-dose group [(15±5) mmol/L] (<0.05). The LOS and hospitalization cost in the low-dose group from the spine-related group were (9±4) d and (10 583±4 851) yuan, respectively, which were less than those in the medium-dose group [(11±3) d and (15 202±7 418) yuan] and high-dose group [(13±6) d and (18 100±4 138) yuan] (all <0.05); however, there was no significant difference among different subgroups in the herpes zoster group (all >0.05). When used in the patients with T2DM undergoing minimally invasive procedures for spine-related diseases, low-dose glucocorticoids can obtain more clinical benefit than high dose, and high dose can lead to raised blood glucose, prolong the LOS, and increase the hospitalization cost.
探讨不同剂量糖皮质激素对2型糖尿病（T2DM）患者微创手术的影响，优化微创手术临床路径。回顾性分析2017年5月至2020年5月四川大学华西医院疼痛科收治的284例行微创手术的T2DM患者的临床资料。根据主要诊断类型将患者分为两组：脊柱相关组（n = 148）和带状疱疹组（n = 136）。根据住院期间单位体表面积糖皮质激素（GCs）的累积剂量，将患者进一步分为三个亚组：低剂量组（GCs<3.5 mg/m²）、中剂量组（3.5 mg/m²≤GCs<7 mg/m²）和高剂量组（GCs≥7 mg/m²）。比较两组不同亚组患者的临床特征。比较两组疾病三个亚组中糖皮质激素对疼痛强度、血糖、住院时间（LOS）和总住院费用的影响。两组患者术前年龄、性别、身高、体重、视觉模拟评分（VAS）和空腹血糖比较，差异均无统计学意义（均P>0.05）。脊柱相关组低剂量组VAS评分为4.5±1.6，高于中剂量组（3.5±1.3）（P = 0.004）。带状疱疹组中剂量组VAS评分为4.3±1.3，高剂量组为4.4±1.6，均高于低剂量组（3.5±0.9）（P = 0.006）。血糖方面，脊柱相关组低剂量组对手术前后空腹血糖的影响小于中剂量组（P = 0.013）。带状疱疹组中，低剂量组血糖为（11±5）mmol/L，对住院期间血糖波动的影响小于高剂量组[（15±5）mmol/L]（P<0.05）。脊柱相关组低剂量组LOS和住院费用分别为（9±4）d和（10 583±4 851）元，均低于中剂量组[（11±3）d和（15 202±7 418）元]及高剂量组[（13±6）d和（18 100±4 138）元]（均P<0.05）；而带状疱疹组不同亚组间差异无统计学意义（均P>0.05）。对于行脊柱相关疾病微创手术的T2DM患者，低剂量糖皮质激素比高剂量能获得更多临床益处，高剂量会导致血糖升高、延长LOS并增加住院费用。
