Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
J Clin Neurosci. 2024 Jun;124:137-141. doi: 10.1016/j.jocn.2024.04.031. Epub 2024 May 4.
Severe perioperative hyperglycemia (SH) is a proven risk factor for postoperative complications after craniotomy. To reduce this risk, it has been proposed to implement the standardized clinical protocol for scheduled perioperative blood glucose concentration (BGC) monitoring. This would be followed by intravenous (IV) insulin infusion to keep BGC below 180 mg/dl in the perioperative period. The aim of this prospective observational study was to assess the impact of this type of protocol on the postoperative infection rate in patients undergoing elective craniotomy.
A total of 42 patients were prospectively enrolled in the study. Protocol included scheduled BGC monitoring in the perioperative period and rapid-acting insulin IV infusion when intraoperative SH was detected. The diagnosis of infection (wound, pulmonary, blood stream, urinary tract infection or central nervous system infection) was established according to CDC criteria within the first postoperative week. A previously enrolled group of patients with sporadic BGC monitoring and subcutaneous insulin injections for SH management was used as a control group.
An infectious complication (i.e., pneumonia) was diagnosed only in one patient (2 %) in the prospective group. In comparison with the control group, a decrease in the risk of postoperative infection was statistically significant with OR = 0.08 [0.009 - 0.72] (p = 0.02). Implementation of the perioperative BGC monitoring and the correction protocol prevented both severe hyperglycemia and hypoglycemia with BGC < 70 mg/dl.
Scheduled BGC monitoring and the use of low-dose insulin infusion protocol can decrease the postoperative infection rate in patients undergoing elective craniotomy. Future studies are needed to prove the causality of the implementation of such a protocol with an improved outcome.
严重围手术期高血糖（SH）是开颅术后术后并发症的已知危险因素。为了降低这种风险，有人提出实施围手术期血糖浓度（BGC）监测的标准化临床方案。然后，通过静脉内（IV）胰岛素输注将 BGC 在围手术期保持在 180mg/dl 以下。本前瞻性观察研究的目的是评估这种类型的方案对择期开颅术患者术后感染率的影响。
共有 42 名患者前瞻性纳入研究。方案包括围手术期定期 BGC 监测和术中发现 SH 时快速起效胰岛素 IV 输注。根据 CDC 标准，在术后第一周内确定感染（伤口、肺部、血流、尿路感染或中枢神经系统感染）的诊断。先前纳入的一组患者接受了零星 BGC 监测和皮下胰岛素注射来管理 SH，作为对照组。
在前瞻性组中，只有 1 名患者（2%）诊断出感染性并发症（即肺炎）。与对照组相比，术后感染风险降低具有统计学意义，OR=0.08 [0.009-0.72]（p=0.02）。实施围手术期 BGC 监测和校正方案可预防 BGC<70mg/dl 时的严重高血糖和低血糖。
定期 BGC 监测和使用低剂量胰岛素输注方案可以降低择期开颅术患者的术后感染率。需要进一步的研究来证明实施这种方案与改善结果之间的因果关系。
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