全麻患者围术期中心静脉血糖与手指末端血糖的相关性

Relationship between central venous blood glucose and peripheral blood glucose under intravenous-inhalation combined anesthesia

目的探讨全麻患者围术期中心静脉血糖(CVG)与手指末端血糖(PBG)的相关性。方法本研究选择开放中心静脉通路的全身麻醉手术患者68例,男43例,女25例,年龄18~85岁,ASAⅠ-Ⅲ级。分别在麻醉前(T0)、麻醉诱导后5 min(T1)、手术开始30 min(T2)、手术结束即刻(T3)采血测定CVG和PBG,并计算两者差值ΔBG=CVG-PBG。采用Bland-Altman分析CVG与PBG的一致性;两者的相关性采用Pearson相关分析。结果 Bland-Altman分析显示T0-T3四个时点中,每个时点均有3个(4.4%)检测值位于一致性界限(LoA)范围外,CVG与金标准PBG保持一致性,且CVG与PBG呈高度相关(T0:r=0.938,P<0.001;T1:r=0.815,P<0.001;T2:r=0.845,P<0.001;T3:r=0.906,P<0.001)。T1-T3时CVG均明显高于PBG(P<0.001);T0-T2时CVG明显低于T3时(P<0.001);T1、T2时PBG明显低于T0和T3时(P<0.001);T1-T3时ΔBG明显高于T0时(P<0.001)。结论在静-吸复合全身麻醉中CVG与PBG存在高度线性正相关,CVG或可代替PBG。

Objective To explore the correlation between central venous and peripheral blood glucose patients under general anesthesia. Methods A total of 68 patients, aged 18-85 years, ASA physical status Ⅰ-Ⅲ, elective surgical procedures with central vena catheterization under general anesthesia were included Central venous blood glucose(CVG) and peripheral blood glucose(PBG) were detected before anesthesia(T0), 5 min after anesthesia induction(T1), 30 min after surgery beginning(T2) and immediately after the operation(T3). The difference between CVG and PBG(ΔBG) was calculated. Pearson correlation coefficient and Bland-Altman analysis were used to investigate the relationship between CVG and PBG. Results Bland-Altman analysis showed 3 of 68 were out of limits of agreement(LoA) at T0-T3 four time points with a ratio of 4.4%, which demonstrated that CVG was consistent with PBG, and at these four time points, CVG was correlated especially with PBG(T0: r = 0.938, P < 0.001;T1: r = 0.815, P < 0.001;T2: r = 0.845, P < 0.001;T3: r = 0.906, P < 0.001). At T1-T3 time points, CVG was higher than PBG(P < 0.001);and CVG at T0-T2 was lower than T3(P<0.001);PBG at T1, T2 was lower than at T0 and T3(P < 0.001);and the differences between CVG and PBG(ΔBG) at T1-T3 were higher than at T0(P < 0.001). Conclusion CVG is correlated especially with PBG of patients, which may provide a theoretical basis for replacing CVG with PBG during perianesthesia clinically.