应激性高血糖对上腹手术患者预后的影响

Effect of Postoperative Stress Hyperglycemia on the Prognosis of Patients Undergoing Epigastric Surgery

目的探讨应激性高血糖(stress hyperglycemia,SHG)对上腹手术患者预后的影响。方法选择行上腹部腹腔镜手术的患者163例,根据术后24 h患者空腹血糖水平分为A组(3.9 mmol/L≤血糖<10.0 mmol/L)96例和B组(血糖≥10.0 mmol/L)67例,统计两组患者术后低血糖发生率、手术并发症(切口感染、腹腔感染、肺部感染、败血症)发生率和住院时间。结果 A组患者术后低血糖发生率15.6%高于B组0.0%;B组患者切口感染率17.9%高于A组8.3%;B组患者腹腔感染率13.4%高于A组3.1%;B组患者肺部感染率16.4%高于A组7.3%;B组患者败血症发生率11.9%高于A组3.1%;B组患者住院时间(26.94±3.17)d长于A组(20.73±3.26)d,差异均有统计学意义(P<0.05)。结论上腹手术后SHG可能增加感染发生率,减慢患者恢复速度,血糖为7.8~10.0mmol/L可作为术后血糖控制目标。

ObjectiveTo investigate the effect of postoperative stress hyperglycemia on the prognosis of patients undergoing epigastric surgery. Methods163 patients undergoing upper abdominal laparoscopic surgery were selected. The patients were divided into two groups： A group （3.9 mmol/L≤GLU〈10.0 mmol/L） and B group （GLU≥10.0 mmol/L）. The incidences of hypoglycemia, complications, incisional infection, abdominal infection, pulmonary infection, septicemia and the average length of hospital stay were calculated and analyzed according to the fasting blood glucose level of 24 hour after operation. ResultsThe incidence of hypoglycemia in A group 15.6% was higher than B group 0.0%; the rate of incision infection in B group was 17.9% higher than B group 8.3%; the rate of intra abdominal infection in B group was 13.4% higher than A group 3.1%; the rate of pulmonary infection in B group was 16.4% higher than A group 7.3%; the rate of septicemia in B group was 11.9% higher than A group 3.1%. All the above differences were statistical significance （P〈0.05）. ConclusionSHG can increase the incidence of infection after abdominal surgery, slow the recovery rate of patients. Blood glucose control 7.8-10.0 mmol/L can be used as postoperative blood sugar control targets.