非糖尿病患者术中高血糖的发生率及危险因素：一项前瞻性观察研究。
Incidence and risk factors of intraoperative hyperglycemia in non-diabetic patients: a prospective observational study.
机构信息
Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand.
出版信息
BMC Anesthesiol. 2022 Sep 10;22(1):287. doi: 10.1186/s12871-022-01829-9.
BACKGROUND
Intraoperative hyperglycemia has been associated with multiple postoperative complications such as surgical site infection, myocardial infarction, stroke, and death. These complications are not confined to only diabetic patients. However, the incidence of intraoperative hyperglycemia in non-diabetic patients has not been fully elucidated. Additionally, these patients' risk factors were not well established in previous studies.
METHODS
Four hundred forty non-diabetic patients who underwent intermediate- to high-risk surgery were included in the study. We prospectively measured the capillary blood glucose level in all patients during surgery. The incidence of intraoperative hyperglycemia was defined as at least one episode of blood glucose level of more than 180 mg/dL. Risk factors for hyperglycemia were assessed using multivariable logistic regression analysis.
RESULTS
Sixty-five (14.7%) patients developed hyperglycemia during surgery. The independent risk factors for intraoperative hyperglycemia were an American Society of Anesthesiologists status ≥ 3 (odds ratio [OR] 6.09, 95% confidence interval [CI]: 2.67-13.89, p < 0.001), preoperative impaired fasting blood sugar (OR 2.28, 95%CI:1.13-4.61, p = 0.021), duration of anesthesia ≥ 3 h (OR 4.06, 95%CI: 1.23-13.45, p = 0.021), intraoperative hypotension (OR 5.37, 95%CI: 2.35-12.29, p < 0.001), intraoperative blood transfusion (OR 4.35, 95%CI: 2.15-8.79, p < 0.001), and steroid use (OR 2.39, 95%CI: 1.20-4.76, p = 0.013). Surgical site infection was higher in patients with intraoperative hyperglycemia compared with patients without intraoperative hyperglycemia (4 [6.1%] vs. 6 [1.6%], respectively, p = 0.035).
CONCLUSION
The incidence of intraoperative hyperglycemia was significant in non-diabetic patients during intermediate- to high-risk surgery. Risk factors should be identified to prevent intraoperative hyperglycemia.
TRIAL REGISTRATION
The study was prospectively registered at https://www.thaiclinicaltrials.org (TCTR20191114001).
背景
术中高血糖与多种术后并发症有关，如手术部位感染、心肌梗死、中风和死亡。这些并发症不仅限于糖尿病患者。然而，非糖尿病患者术中高血糖的发生率尚未完全阐明。此外，以前的研究并未明确这些患者的危险因素。
方法
本研究纳入了 440 例接受中高危手术的非糖尿病患者。我们前瞻性地测量了所有患者手术期间的毛细血管血糖水平。术中高血糖的定义为至少一次血糖水平超过 180mg/dL。使用多变量逻辑回归分析评估高血糖的危险因素。
结果
65 例（14.7%）患者在手术中发生高血糖。术中高血糖的独立危险因素为美国麻醉医师协会（ASA）分级≥3 级（比值比 [OR] 6.09，95%置信区间 [CI]：2.67-13.89，p<0.001）、术前空腹血糖受损（OR 2.28，95%CI：1.13-4.61，p=0.021）、麻醉时间≥3 小时（OR 4.06，95%CI：1.23-13.45，p=0.021）、术中低血压（OR 5.37，95%CI：2.35-12.29，p<0.001）、术中输血（OR 4.35，95%CI：2.15-8.79，p<0.001）和激素使用（OR 2.39，95%CI：1.20-4.76，p=0.013）。与无术中高血糖的患者相比，术中发生高血糖的患者手术部位感染发生率更高（4 例 [6.1%] vs. 6 例 [1.6%]，p=0.035）。
结论
在中高危手术期间，非糖尿病患者术中高血糖的发生率较高。应识别危险因素以预防术中高血糖。
试验注册
该研究前瞻性地在 https://www.thaiclinicaltrials.org 注册（TCTR20191114001）。
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