术中控制血糖波动水平与术后血清炎症因子对颅内肿瘤患者短期预后的影响

Effects of Control Intraoperative Glucose Fluctuation and Postoperative Levels of Inflammatory Cytokines on Short-term Prognosis of Patients with Intracranial Tumor

目的研究颅内肿瘤术中血糖波动水平与术后血清炎症因子对患者短期预后的影响。方法入选颅内肿瘤择期手术患者97例,根据术中血糖波动水平分为:血糖波动<1 mmol/L的A组(32例),血糖波动≥1.0 mmol/L且≤2.0 mmol/L的B组(35例),血糖波动>2.0 mmol/L的C组(30例)。分别测量患者术前1 d空腹血糖(G1)、麻醉5min血糖(G2)、术中每隔20 min测量一次血糖记录最高值(G3)和最低值(G4)、术后5 min血糖(G5)、术后1 h血糖(G6)、术后2 h血糖(G7)。分别于术前1 d和术后当天(0 d)、1 d、3 d、5 d、7 d检测血清TNT-α、IL-6和CRP水平;记录所有患者术后房颤、心肌缺血、高低血糖患者数量,以及死亡情况。结果血糖水平与同组G1相比,B、C组G3~G7均显著升高(P<0.05),B组G3~G7和C组G3、G5均显著高于同期A组水平(P<0.05)。与术前1 d比较,术后0、1、3、5、7 d 3组患者血清TNF-α、IL-6、CRP水平均显著升高,差异均有统计学意义(P<0.05)。B、C组与A组比较,术后0、1、3、5、7 d患者血清TNF-α、IL-6、CRP水平均显著升高,差异有统计学意义(P<0.05)。C组与B组比较,术后0、1,3,5 d血清TNF-α、IL-6、CRP水平均显著升高,差异有统计学意义(P<0.05)。3组均无死亡情况发生。术后7 d,B组和C组房颤、心肌缺血、高血糖、低血糖情况均显著高于A组(P<0.05)。与B组相比,C组高血糖发生情况显著增高(P<0.05)。结论术中血糖波动水平越小,患者预后越好。术后炎症因子水平与患者短期预后相关,浓度越高,预后越差。

Objective To investigate the effects of intraoperative glucose fluctuation and postoperative levels of inflam- matory cytokines on short-term prognosis of patients with intracranial tumor. Methods 97 patients who underwent selective oper- ation divided into 3 groups according to the intraoperative glucose fluctuation. They were group A （ glucose fluctuation 〈 1 mmol/ L,32 cases）, group B （glucose fluctuation ~〉 1.0 mmol/L and ~〈 2.0 mmol/L, 35 cases）, group C （glucose fluctuation 〉 2.0 mmol/L,30 cases）. Glucose were measured at 1 day before operation （G1） ,5 minutes after induction of anesthesia （G2） ,20 mi- nutes after operation （ G5 ）, 1 hour after operation （G6） ,2 hours after operation （ G7 ）. During surgery, glucose levels were contin- uously detected every 20 minutes since the surgery begin, and the maximum value recorded as G3 and the minimum value recor- ded as G4. Blood samples were obtained for TNT-ot, IL-6 and CRP at 1 day before operation （ T1 ）, 0 day （ T2）, 1 day （ T3 ）, 3 days （T4） ,5 days （ T5 ） ,7 days after operation （T6）. The incidence of postoperative atrial fibrillation, myocardial ischemia, hy- perglycemia,hypoglycemia and death were recorded. Results G3 ~ G7 in group B and C were higher compared with G1 in them- selves group （ P 〈 0.05）. And they were significantly higher compared with group A （ P 〈 0.05 ）. Compared with T1, concentra- tions of postoperative serum TNF-ct, IL-6 and CRP （ T2,13, T4,15, T6 ） were significantly higher in the 3 groups （ P 〈 0.05 ）. Compared with group A, concentrations of postoperative serum TNF-a, IL-6 and CRP （T2, T3, T4, I5, T6）were significantly high- er in group B and C （P 〈 0.05 ）. Compared with group B, concentrations of postoperative serum TNF-ot, IL-6 and CRP （ tiE, T3, T4, T5 ） were significantly higher in group C （ P 〈 0.05 ）. And the incidences of postoperative atrial fibrillation, myocardial ische- mia, hyperglycemia, hypoglycemia were significantly higher in group B and C （P 〈 0.05 ）. Compared with group B, hyperglycemi- a, hypoglycemia were significantly higher in group C （P 〈 0.05）. The 3 groups had no deaths. Conclusion Glucose fluctuation is lower, the short-term prognosis in patients with intracranial tumor is better. Postoperative levels of inflammatory cytokines is re lated to the short-term prognosis, the higher the concentration,the worse prognosis.