is a CRNA at Baylor Scott & White Medical Center, Grapevine, Texas. At the time of this study, this author was a student at Texas Wesleyan University Graduate Programs of Nurse Anesthesia, Fort Worth, Texas.
is a CRNA at Mountainside Medical Center in Glenridge, New Jersey. At the time of this study, this author was a student at Texas Wesleyan University Graduate Programs of Nurse Anesthesia, Fort Worth, Texas.
AANA J. 2023 Jun;91(3):185-193.
The purpose of this review was to examine the effect of single-dose dexamethasone on perioperative blood glucose in diabetic patients. We used PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and grey literature for our search. Only randomized controlled trials were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE systems. We analyzed seven trials involving 1,321 patients. Diabetic patients treated with single-dose dexamethasone had statistically significant changes in blood glucose levels from baseline by 33.61 mg/dL (MD, 33.61; 95% CI, 17.59 to 49.63; < .0001). Dexamethasone increased blood glucose levels 1-4 hours (MD, 29.02; 95% CI, 7.09 to 50.94; = .010), 8-24 hours (MD, 30.81; 95% CI, 9.21 to 52.41; = .005) after administration and increased risks of hyperglycemia. However, there was no difference in surgical site infection (SSI) (RR, 0.81; 95% CI, 0.59 to 1.11; = .19). Effect size imprecision, substantial heterogeneity, and publication bias was the study's limitations. We found that single-dose dexamethasone increased glucose concentration 24 hours after surgery with little to no effect on SSI. Extrapolation of these findings to clinical settings must take into consideration the review's limitations.
本次综述的目的在于研究单剂量地塞米松对糖尿病患者围手术期血糖的影响。我们在 PubMed、Cochrane Library、MEDLINE、CINAHL、Google Scholar 和灰色文献中进行了检索。仅纳入随机对照试验。使用合适的效应模型来评估风险比（RR）和均数差值（MD）。使用偏倚风险和 GRADE 系统评估证据质量。我们分析了涉及 1321 名患者的 7 项试验。与基线相比，接受单剂量地塞米松治疗的糖尿病患者的血糖水平有统计学意义的变化，差值为 33.61mg/dL（MD，33.61；95%CI，17.59 至 49.63；<0.0001）。地塞米松在给药后 1-4 小时（MD，29.02；95%CI，7.09 至 50.94；=0.010）和 8-24 小时（MD，30.81；95%CI，9.21 至 52.41；=0.005）时升高血糖水平，并增加了发生高血糖的风险。然而，手术部位感染（SSI）的风险并无差异（RR，0.81；95%CI，0.59 至 1.11；=0.19）。研究的局限性在于效应大小不精确、存在显著异质性和发表偏倚。我们发现，单剂量地塞米松可使术后 24 小时的血糖浓度升高，但对 SSI 几乎没有影响。将这些发现外推至临床环境时，必须考虑到本综述的局限性。
