糖尿病病人围手术期危险因素的评估

Evaluation of Perioperative Risks in Diabetic Patients

分析该院近10年的糖尿病住院手术患者187例,评估其围手术期危险因素。围手术期临床特征分为:性别,年龄,糖尿病病程,合并高血压/冠心病,术前高血糖,手术时间,术后平均血糖,麻醉方式,手术种类。术后并发症中轻型包括切口感染,重型包括心、肺、肾功能衰竭,卒中,代谢失代偿,或死亡。单因素Logistic回归分析显示,与术后严重并发症发生有关的因素包括:年龄,术前高血糖,合并高血压、冠心病,手术时间长,麻醉方式(P<0.05)。Logistic多元回归分析显示:术后严重并发症仅与合并冠心病(OR 10.98,P=0.001,r=0.2586)和手术时间长(OR 6.19,P=0.007 2,r=0.2187)有关。死亡与术前高血糖(≥13.3mmol/L)有关(OR 6.5,P<0.05)。另外,五官科手术无一出现术后并发症,与非五官科手术比具极显著意义(P<0.001)。因此围手术期重要的危险因素是:年龄≥65岁,术前存在高血压、冠心病,术前血糖≥13.3mmol/L,手术时间≥90分,脊髓或全身麻醉等。其中尤以冠心病和手术时间长最为重要。

187 diabetic patients who underwent surgical operations were retrospectively analysed and their perioperative risk factors were evaluated. Preoperative clinical characteristics consisted of sex, age,duration of diabetes, presence of hypertension and /or coronary heart disease (CHD) , hyperglycemia, duration of surgery,postoperative mean blood glucose levels,and kinds of anesthesia. Postoperative complications were divided into moderate group(wound infection) and serious group (including heart,lung and renal failure, stroke, metabolic decompensation, acid-base imbalance, ketoacidosis, diabetic coma or death). Single logistic analysis showed that serious postoperative complications were .associated with age,preoperative hyperglycemia,presence of hypertension and/or CHD,long time operation,kinds of anesthesia(P<0. 05). Multiple logistic analysis showed that serious postoperative complications only related to presence of CHDCOR 10. 98,P=0. 001,r=0. 258 6)and long time of operation (OR 6. 19, P= 0. 007 2,r = 0. 218 7). Operative mortality was related to preoperative hyperglycemia(≥13. 3mmol/L, OR 6. 5.P<0. 05). In addition, there were no any postoperative complications in eye-ear-uose-throat surgery. It is concluded that the important perioperative risk factors included:age≥65 years,presence of hypertension and/or CHD,preoperative hyperglycemia(≥13. 3mmol/L) ,operation lasting more than 90 mins,spinal or general anesthesia. CHD and long time operation were the major ones.