颅内肿瘤手术控制术中血糖波动水平与术后血清炎症因子及患者短期预后关系的研究

Relationship among intraoperative glycemia fluctuation, postoperative levels of inflammatory factors and short-term prognosis in patients receiving the surgical treatment of intracranial tumor

目的：探讨颅内肿瘤手术术中控制血糖波动水平与术后肿瘤坏死因子－α（ TNF－α）、白细胞介素－6（IL－6）和C反应蛋白（CRP）浓度及患者短期预后的关系。方法择期无糖尿病颅内肿瘤切除患者60例，随机分成3组，每组20例。 A组患者术中控制血糖＜2．0 mmol／L，B组患者术中控制血糖在2．0～4．0 mmol／L，C组患者术中控制血糖在4．1～6．0 mmol／L。我们按照以下固定时间进行血糖测定：术前1天空腹血糖（ T0）；麻醉诱导后5 min（ T1）血糖；在T1和T4之间每隔15 min进行1次血糖测定，记录术中最高血糖（峰血糖T2）和术中最低血糖（谷血糖T3）、关颅后5 min（T4）和入ICU即刻（T5）血糖以及回ICU后2 h（T6）的血糖。分别在术前1天和术后1、3、6天检测患者空腹血清TNF－α、IL－6和CRP浓度，观察并记录术前和术后房颤发生率、心肌缺血率以及术后高血糖和低血糖发生率、呼吸支持时间。结果 A组与B组患者术前、术后各项观察和检测指标的差异无统计学意义（P＞0．05）。与C组相比，A、B组患者术后高血糖和低血糖发生率低（P＜0．05），术后各观察点TNF－α、IL－6和CRP浓度低（P＜0．05），术后房颤发生率、心肌缺血率低和呼吸支持时间短（P＜0．05）。结论在颅内肿瘤手术患者中，术中血糖波动与术后血清炎症因子TNF－α、IL－6和CRP浓度有一定关系，控制血糖波动小于4．0 mmol／L可以改善患者短期预后。

Objective To investigate the relationship among intra -operative glycemia fluctuation , postoperative levels of inflammatory factors --tumor necrosis factor-α（ INF-α） , interleukin-6 （ IL-6 ） and C-reactive protein （ CRP） and short-term prognosis in patients receiving surgical treatment of intracranial tumor .Methods A total of 60 non-diabetic patients who would undergo intracranial tumor surgery were enrolled into the current study and randomly di -vided into three groups （n=20 each）.The intra-operative blood glucose concentration was less than 2.0 mmol/L for Group A, between 2.0 and 4.0 mmol/L for Group B and between 4.1 and 6.0 mmol/L for Group C.The level of blood glucose was determined at the following time points：one day before operation （ T0 ） , 5 min after induction of anesthesia （ T1 ）;every 30 min from T1 to T4 .The maximum and the minimum blood glucose concentrations during operation （ T2 and T3） were recorded.Furthermore, the level of blood glucose was determined 5 min after closure of cranium （T4）, im-mediate entry into ICU （ T5 ） and 2 h after entry into ICU （ T6 ） .The concentrations of serum INF -α, IL-6 and CRP were measured 1 day before and 1, 3, and 6 days after operation .The incidences of preoperative and postoperative atrial fibrillation, myocardial ischemia, postoperative hyperglycemia and hypoglycemia , and duration of mechanical ventilation were observed .Results There was no statistical difference between Groups A and B in the above preoperative and post -operative indicators （P〉0.05）.Compared with patients in Group C, those in Groups A and B produced low incidence of postoperative hyperglycemia, hypoglycemia and atrial fibrillation, and myocardial ischemia （P〈0.05）, reduced levels of postoperative serum INF -α, IL-6 and CRP （P〈0.05）, and short duration of mechanical ventilation （P〈0.05）. Conclusion Intraoperative glycemia fluctuation is related to the postoperative concentrations of serum INF -α, IL-6 and CRP.The short-term prognosis can be improved if patients＆#39;blood glucose is less than 4.0 mmol/L.