手术时长与内眼手术围手术期血糖波动的相关分析

Correlation between changes in blood glucose levels and the duration of surgery in the perioperative period

目的控制血糖波动是目前糖尿病防控的新关注点,论文重点研究手术时长对内眼手术后血糖变化的影响,同时分析影响血糖波动幅度的相关临床因素,为该类患者的围手术期血糖管理提供参考依据。方法搜集2016年1月至2017年5月收治的糖尿病合并眼部疾病并接受内眼手术的患者132例。所有患者接受以下时间点的血糖测定:手术前空腹血糖、手术前即时血糖、手术后30 min血糖、术后第1天空腹血糖、术后第1天相应手术前时间点血糖、术后第2天空腹血糖、术后第2天相应手术前时间点血糖,采用配对t检验比较手术前后患者血糖变化。术后30 min与术前即时血糖的差值为术后30 min的血糖变化值(BGC),术后第1天相应时间点、术后第2天相应时间点与术前相应时间点的血糖差值分别为术后1 d时间点BGC和术后2 d时间点BCG,术后第1天空腹血糖、术后第2天空腹血糖与手术前空腹血糖的差值分别为术后1天空腹BCG和术后2天空腹BCG。按照手术时间长短将患者分为三组:短组(手术时间≤30 min)、中组(手术时间31~90 min)、长组(手术时间>90 min)。根据术前即时血糖将患者分为两组:即时血糖低组(术前血糖≤10 mmol/L)、即时血糖高组(术前血糖>10 mmol/L)。根据术前空腹血糖将患者分为两组:空腹血糖低组(术前空腹血糖≤8.33 mmol/L)、空腹血糖高组(术前空腹血糖>8.33 mmol/L)。依据糖尿病确诊后的病程,将患者分为三组:短组(病程在≤5年)、中组(5年<病程<10]年)、长组(病程>10年)。结果132例患者术前即时血糖平均为(9.81±1.29)mmol/L,术后30 min为(13.04±1.83)mmol/L,两者比较有统计学差异。术后第1天(11.03±1.16 mmol/L)、第2天(10.10±1.47 mmol/L)相应时间点的血糖较手术前(9.81±1.29 mmol/L)血糖升高,差异有统计学意义。术后30 min BGC,短组(1.86±1.71 mmol/L)、中组(3.20±2.01 mmol/L)与长组(3.50±2.13 mmol/L)之间两两比较差异均有统计学意义;术后1 d相同时间点、术后1 d空腹、术后2 d空腹的BGC,短组与中组、短组与长组比较差异均具有统计学意义,中组与长组比较差异不具有统计学意义;术后2 d相同时间点的BGC,短组(0.37±0.75 mmol/L)、中组(0.28±0.56 mmol/L)、长组(0.19±1.00 mmol/L)两两比较差异无统计学意义。手术时间与术后30 min BCG、术后1 d相同时间点BCG、术后1 d空腹BCG、术后2 d空腹BCG的相关系数分别为:0.255、0.205、0.228、0.236(P<0.05)。术前空腹血糖低组BGC较空腹血糖高组术后30 min及术后2 d空腹BGC高、而术后1 d空腹BGC低,术前即时血糖低组BGC较即时血糖高组在术后30 min和术后1 d时间点BGC高。各时间点短组、中组、长组之间两两比较,血糖变化值均无统计学差异。结论糖尿病患者在眼科手术后30 min及术后第1天血糖水平升高,术后第2天大致恢复至术前水平。手术时间与术后早期血糖波动幅度呈正相关,缩短手术时间、实时调控术前血糖有利于减少围手术期的血糖波动。糖尿病病程对手术前后血糖波动影响不大。

Objective To prevent and treat diabetes,it is necessary to monitor the fluctuation in blood glucose levels.This study provides a reference for the perioperative clinical monitoring of patients with diabetes by studying the changes in blood glucose levels before and after ocular surgeries and evaluating the factors that influence these changes.Methods We recruited 132 patients with ocular diseases and diabetes from Qilu Hospital,Shandong University between January 2016 and May 2017.All patients underwent blood glucose tests one day before surgery(fasting,2 h after breakfast,2 h after lunch,and at 10 pm)and 30 min to 2 days after surgery.The blood glucose levels before and after surgery were compared using a paired t-test.To study the factors influencing the changes in blood glucose levels,we divided the patients into three groups according to the duration of surgery-short duration group(<30 min),medium duration group(31-90 min),and long duration group(>90 min).Further,we divided patients into two groups according to the preoperative instant blood glucose level-low instant blood glucose group(73 patients with preoperative fasting blood glucose levels≤10 mmol/L)and high instant blood glucose group(59 patients with preoperative fasting blood glucose levels>10 mmol/L).According to the preoperative fasting blood glucose level,patients were divided into two groups-low fasting blood glucose group(62 patients with preoperative fasting blood glucose levels≤8.33 mmol/L)and high fasting blood glucose group(70 patients with preoperative fasting blood glucose levels>8.33 mmol/L).According to the history of diabetes,patients were divided into three groups-short history group(≤5 years),middle history group(5-10 years),and long history group(>10 years).Results The average blood glucose level was 9.81±1.29 mmol/L and 13.04±1.83 mmol/L before surgery and 30 min after surgery,respectively,with an average increase of 3.22±2.19 mmol/L(paired t-test,P<0.01).There were no significant differences between the sexes.Blood glucose levels on the first(11.03±1.16 mmol/L)and second(10.10±1.47 mmol/L)postoperative days were significantly higher than those before surgery.Fasting blood glucose levels on the first postoperative day(8.75±1.26 mmol/L)were higher than those before surgery(8.15±1.64 mmol/L),while fasting blood glucose levels on the second postoperative day(7.63±1.02 mmol/L)were lower than those before surgery(8.15±1.64 mmol/L).Further,changes in blood glucose levels after 30 min of surgery were significantly different between the short duration group(1.86±1.71 mmol/L),the medium duration group(3.20±2.01 mmol/L),and the long duration group(3.50±2.13 mmol/L)(P<0.01).Changes in fasting blood glucose levels on the first and second postoperative days were significantly different between the short and medium duration groups and the short and long duration groups;there was no significant difference between the medium and long duration groups.The low instant blood glucose group showed higher changes in blood glucose levels than the high instant blood glucose group at 30 min after surgery(4.10±2.15 vs 2.13±1.69 mmol/L,P<0.01)and on the first postoperative day(2.02±1.99 vs 0.05±1.11 mmol/L,P<0.01),indicating that patients with higher preoperative blood glucose levels blood glucose levels.Further,the low fasting blood glucose group had higher changes in blood glucose levels than the high fasting blood glucose group at 30 min after surgery(4.10±2.15 vs 2.13±1.69 mmol/L,P<0.01),on the first postoperative day(0.05±1.11 vs 2.02±1.99 mmol/L,P<0.01),and the second postoperative day(0.49±0.49 vs-0.24±0.71 mmol/L).Lastly,there was no significant difference at all time points in terms of changes in blood glucose levels among the three diabetes groups.Conclusion In patients with diabetes,blood glucose levels increased 30 min to one day after ocular surgery and returned to preoperative levels 2 days after surgery.The duration of surgery was positively correlated with changes in blood glucose levels.Shortening the duration of surgery and real-time monitoring of preoperative blood glucose levels are helpful to control of the fluctuations in blood glucose levels in the perioperative period.