高血糖及肥胖对闭合性胆系手术结局的影响

The effect of hyperglycemia and obesity on the condition of patients with closed biliary surgery

目的探讨糖尿病患者不同血糖水平及体重指数(BMI)对闭合性胆系手术结局的影响。方法回顾山西省人民医院2018年1月至2019年6月入院行闭合性胆系手术的424例糖尿病患者临床资料,根据空腹血糖及BMI分为高血糖和非高血糖组及肥胖和非肥胖亚组,对比分析各组间临床资料的差异,多元回归分析术后感染、住院时间及费用的影响因素。结果①与非高血糖组相比,高血糖组BMI、血肌酐、尿素氮、血糖监测率、糖化血红蛋白检测率、术后感染率、ICU入住率、住院时间和费用均高,血清白蛋白水平较低,均P<0.05。②高血糖肥胖亚组年龄、空腹血糖、血肌酐、低密度脂蛋白、住院时间和费用均比高血糖非肥胖亚组低(均P<0.05);非高血糖组中肥胖亚组血肌酐水平较非肥胖亚组高(P<0.05)。③Logistic回归分析显示高血糖是术后感染的独立危险因素,空腹血糖每升高1mmol/L,术后感染风险增加1.158倍,血清白蛋白是术后感染的保护因素。④多元线性回归分析显示高血糖、低白蛋白是住院时间延长、住院费用增加的重要影响因素,均P<0.05。结论高血糖是术后感染的独立危险因素,是住院时间延长和费用增加的相关因素;肥胖除升高血肌酐,与术后感染及住院时间延长无明显关系。接受闭合性胆系手术的糖尿病患者,需提高糖化血红蛋白检测率及血糖监测率,合理管控血糖,适当控制体重。

Objective To investigate the effect of different blood glucose and BMI levels on the outcome of closed biliary surgery in diabetic patients.Methods Clinical data of 424 diabetes admitted to Shanxi Provincial People’s Hospital for closed biliary tract surgery from Jan.2018 to Jun.2019 were retrospectively analyzed.According to the fasting blood glucose and BMI levels,the subjects were divided into hyperglycemia and non-hyperglycemia groups and obesity and non-obesity subgroups.The differences of clinical data among different groups were compared and analyzed.Multiple regression analysis was used to analyze the factors of postoperative infection,length and cost of hospitalization.Results①Compared with the non-hyperglycemia group,the hyperglycemia group had higher BMI,serum creatinine,blood urea nitrogen,blood glucose monitoring rate,glycated hemoglobin detection rate,postoperative infection rate,ICU occupancy rate,length and cost of hospitalization,and lower albumin level,all P<0.05.②The age,fasting blood glucose,serum creatinine,low density lipoprotein,length and cost of hospitalization in the hyperglycemic obese subgroup were all lower than those in the non-obese subgroup,all P<0.05;and the serum creatinine in the obese subgroup was higher than those in the non-obese subgroup(P<0.05).③Logistic analysis revealed that hyperglycemia was an independent risk factor for postoperative infection.For every 1mmol/L increase in fasting blood glucose,the risk of postoperative infection increased by 1.158 times,and albumin was a protective factor for postoperative infection.④Multiple linear regression analysis showed that hyperglycemia and hypoalbumin were the important factors affecting the length of hospital stay and the increase of hospital cost,all P<0.05.Conclusions Hyperglycemia is an independent risk factor for postoperative infection and a risk factor for longer hospital stay and higher costs.Obesity is not associated with postoperative infection or longer hospital stay,except for increased serum.Patients with diabetes undergoing closed biliary system surgery need to improve the detection rate of glycated hemoglobin and blood glucose monitoring rate,manage blood glucose reasonably,and control body weight appropriately.