原发性肝癌术后发生高血糖影响因素的临床研究

Clinical study on influencing factors of postoperative hyperglycemia occurred in primary liver cancer patients

[目的]探讨肝癌病人术后发生高血糖的影响因素,为制订有针对性的预防和降低高血糖发生护理措施提供依据。[方法]96例肝癌切除病人,根据术后第1天06:00时随机血糖值分为高血糖组(随机血糖≥11.1mmol/L)和正常组,采用单因素分析比较两组间术前禁食时间、手术时间等16项变量对术后血糖水平的影响,对单因素分析筛选出术后发生高血糖的影响因素,进行非条件多因素Logistic回归分析。[结果]肿瘤直径、手术时间、术中出血量、接台手术、术前凝血酶原时间、术前前白蛋白水平对病人术后血糖水平有影响,进一步多因素Logistic回归分析,发现肿瘤直径越大、术前凝血酶原时间(PT)越长、术前前白蛋白(PA)水平越低,接台手术术前等待时间越久,病人术后血糖水平越高。[结论]术前改善肝功能,做好接台手术等待期间的观察和护理,可有效预防和降低术后高血糖的发生。

Objective： To probe into the influencing factors of postoperative hyperglycemia occurred in hepatic cancer patients and provide evidences for making targeted prevention and nursing interventions for reducing occurrence of hyperglycemia. Methods：A total of 96 cases of hepatic cancer patients undergoing resection were divided into hyperglycemia group （random blood glucose≥11.1mmol/L） and normal control group according to random blood glucose values at 06：00 on the postoperative first day. The influence of 16 variables such as preoperative fasting time and operation duration on postoperative blood glucose levels was compared between two groups by using univariate analysis. The influencing factors of postoperative hyperglycemia were screened by univariate analysis,and they were analyzed by using non--conditional multivariate logistic regression analysis. Results：Tumor diameters,oprative duration,intraoperative bleeding loss, then sets surgery, preoperative prothrombin time and preoperative prealbumin levels had impacts on postoperative blood sugar level of patients. And further multivariate Logistic regression analysis found that the larger tumor diameter was, the longer preoperative prothrombin time （PT） was,the lower preoperative prealbumin（PA） levels was,and the longer waiting time of then sets surgery was, the higher levels of blood glucose of postoperative patients was. Conclusion： Preoperative improve liver function and do well observation and care of patients during waiting period of then sets surgery can effectively prevent and reduce the incidence of postoperative hyperglycemia.