良好控制围术期血糖对老年胃癌并存糖尿病患者手术耐受性和术后恢复的影响  

Clinical effects of a good control of blood sugar during perioperative period on surgical tolerance and postoperative recovery in elderly patients with gastric cancer and diabetes

作　　者：张蕴[1] 周宁宁[1] Zhang Yun;Zhou Ningning(Operating Room,Hangzhou First People's Hospital Affiliated to Zhejiang University,Hangzhou 310006,China)

机构地区：[1]浙江大学附属杭州市第一人民医院手术室,310006

出　　处：《中华老年医学杂志》2021年第4期475-478,共4页Chinese Journal of Geriatrics

基　　金：浙江省医药卫生科技计划项目(浙江省医药卫生科研基金,2019KY127)。

摘　　要：目的:探讨老年胃癌合并糖尿病患者的围术期应用血糖控制措施的临床效果。方法:选取2018年8月至2020年3月本院所收治的胃癌合并糖尿病患者92例,均接受手术治疗,按照随机、对照原则将其分为对照组(常规围术期处置)和观察组(常规围术期处置联合血糖控制),对两组患者的围术期血糖水平变化、手术情况、术后恢复情况进行观察分析。结果:血糖水平,观察组和对照组患者术前1 d[(7.4±1.1)mmol/L和(7.9±1.3)mmol/L,t=-1.991,P=0.025]、术中[(7.2±0.9)mmol/L和(8.7±1.2)mmol/L,t=-6.782,P=0.000]、术后[(6.9±1.5)mmol/L和(8.5±1.1)mmol/L,t=-5.834,P=0.000]空腹血糖水平均低于对照组;观察组患者手术耐受性优良率(95.65%)高于对照组(80.44%)(χ^(2)=5.059,P=0.024);观察组患者的切口愈合时间[(7.5±1.6)d和(9.7±2.2)d,t=-5.485,P=0.000]、下床时间[(3.3±0.8)d和(4.7±1.3)d,t=-6.221,P=0.000]、住院时间[(10.5±2.7)d和(15.1±3.5)d,t=-7.058,P=0.000]均短于对照组;观察组患者的术后并发症发生率(8.70%)低于对照组(26.09%)(χ^(2)=4.484,P=0.028)。结论:老年胃癌合并糖尿病患者围术期应用血糖控制措施,可有效维持患者围术期血糖处于合理、稳定水平,提高患者的手术耐受性并促进其术后恢复,对于保障手术的安全进行具有十分积极的作用。Objective To investigate clinical effects of a good control of blood sugar during perioperative period on surgical tolerance and postoperative recovery in elderly patients with gastric cancer and diabetes.Methods A total of 92 elderly patients with gastric cancer and diabetes undergoing surgery in our hospital from August 2018 to March 2020 were randomly divided into a control group(taking conventional perioperative care,n=46)and an observation group(taking conventional perioperative care and good glycemic control,n=46).The changes of perioperative blood glucose level,surgical conditions and postoperative recovery in the two groups were observed and analyzed.Results Fasting blood glucose level of observation group and control group was[(7.4±1.1)mmol/L vs.(7.9±1.3)mmol/L,t=-1.991,P=0.025]at 1 d before operation,[(7.2±0.9)mmol/L vs.(8.7±1.2)mmol/L,t=-6.782,P=0.000]during operation,and[(6.9±1.5)mmol/L vs.(8.5±1.1)mmol/L,t=-5.834,P=0.000]after operation.Anyway,fasting blood glucose level was lower in the observation group than in the control group.In observation vs control group,time of incision healing[(7.5±1.6)d vs.(9.7±2.2)d,t=-5.485,P=0.000],time to get out of bed[(3.3±0.8)d vs.(4.7±1.3)d,t=-6.221,P=0.000],length of stay in hospital[(10.5±2.7)d vs.(15.1±3.5)d,t=-7.058,P=0.000]were shorter in observation group than in control group.The incidence of postoperative complications was lower in the observation group than in the control group(8.70%vs.26.09%,χ^(2)=4.484,P=0.028).Conclusions The application of perioperative glycemic control can effectively maintain the perioperative blood glucose at a reasonable and stable level,improve the surgical tolerance and promote the postoperative recovery in elderly patients with gastric cancer and diabetes.And it plays a very positive role in ensuring the safety of surgery.

关 键 词：胃癌 糖尿病 血糖控制 

分 类 号：R735.2[医药卫生—肿瘤] R587.1[医药卫生—临床医学]