围术期停用二甲双胍对糖尿病患者血糖及认知功能影响

Impact of perioperative discontinuation of metformin on blood glucose and cognitive function in diabetic patients

目的探讨围术期停用二甲双胍,改为短效胰岛素控制血糖,对行单侧全髋关节置换术的老龄糖尿病患者术后认知功能及血糖波动的影响。方法选取自2016年1月至2017年1月大连医科大学附属二院收治的79例择期行单侧全髋关节置换术的老龄糖尿病患者为研究对象。将所有患者分为3组,平素应用二甲双胍,围术期继续应用者纳入A组(n=24),平素应用降糖方式中无二甲双胍者纳入B组(n=28),平素应用二甲双胍术前1 d改为短效胰岛素者纳入C组(n=27)。分别应用简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)对患者的认知功能进行评估。结果与术前相比较,3组拔管后5 min MMSE评分均有明显降低,且A组、B组MMSE评分均高于C组,差异有统计学意义(P <0. 05)。术后第1、3、7天,3组MMSE评分较术前均无明显降低,3组间比较,差异均无统计学意义(P> 0. 05)。与术前比较,3组患者拔管后5 min、术后第1、3天MoCA评分均明显降低(P <0. 05)。术后同一时间点MoCA评分比较,A组、B组均高于C组,组间比较,差异有统计学意义(P <0. 05)。3组患者围术期血糖值均有波动,在术中、拔管后5 min、术后1、3、7 d,C组的血糖值均高于A组和B组,差异有统计学意义(P <0. 05)。3组患者术前与术后肾功能(尿素氮、肌酐值)均未见明显改变,组间比较,差异无统计学意义(P> 0. 05)。静止及活动时3组患者VAS评分比较,差异均无统计学意义(P>0. 05)。3组患者恶心呕吐等不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论二甲双胍对术后认知功能的改变未产生明显影响。围术期改为短效胰岛素不利于稳定患者血糖,对短期轻度认知功能会产生不利的影响。

Objective To investigate the effect of perioperative discontinuation of metformin and the control of blood glucose by short-acting insulin on postoperative cognitive function and blood glucose fluctuation in elderly diabetic patients undergoing unilateral total hip arthroplasty（THA）.Methods A retrospective study was performed on 79 cases of elderly patients who underwent THA from January 2016 to January 2017.All patients were divided into 3 groups,Group A（ n =24）,patients took metformin in daily time,continued metformin during perioperative period;Group B（ n =28）,patients usually in the application of hypoglycemic way without metformin;Group C（ n =27）,patients took metformin in daily time,1 day before surgery,short-acting insulin was used.The cognitive function of patients was evaluated by the simple intelligent mental state examination scale（MMSE）and the Montreal cognitive assessment scale（MoCA）.Results MMSE scores in 3 groups significantly reduced after 5 minutes of extubation than that before surgery,and MMSE scores in Group A and Group B were higher than those in Group C（ P 〈0.05）.At day 1,3 and 7 after surgery,MMSE scores of the 3 groups showed no significant reduction compared with those before surgery,and the difference between the three groups was not statistically significant（ P 〉0.05）.MoCA scores were significantly reduced 5 minutes after extubation,1 and 3 days after surgery in all 3 groups compared with those before surgery（ P 〈0.05）.MoCA scores in Group A and Group B were higher than that in Group C at the same time after surgery（ P 〈0.05）.Three groups of patients with perioperative blood glucose levels were fluctuated in operation, 5 minutes after extubation,postoperative 1,3,7 days,blood glucose level in Croup C was higher than that in Group A and Group B （ P 〈 0.05）.The renal function（urea nitrogen and creatinine）of the three groups did not change significantly before and after surgery,and the difference between the groups was not statistically significant（ P 〉0.05）.VAS scores of the three groups were compared at rest and activity and the difference was not statistically significant（ P 〉0.05）.The incidence of adverse reactions such as nausea and vomiting in the three groups was not statistically significant（ P 〉0.05）.Conclusion Metformin dose not significantly affect postoperative changes in cognitive function.The perioperative change to short-acting insulin is not conducive to the stabilization of patients′ blood glucose,and will have adverse effects on short-term mild cognitive function.