老年糖尿病病人术前血糖管理现状及其对骨科手术预后的影响  

Status of preoperative blood glucose management in elderly diabetic patients and its influence on the prognosis of orthopedic surgery

作　　者：李国庆 巫海娣[2] 鞠昌萍[6] 孙美娟[7] 樊垚 刘欢[8] 俞匀[2] 唐伟[2] 桂波 莫永珍 LI Guo-qing;MO Yong-zhen;WU Hai-di;YU Yun;TANG Wei;FAN Yao;GUI Bo;JU Chang-ping;SUN Mei-juan;LIU Huan(College of Nursing,Nanjing Medical University,Nanjing 211166,China;Department of Endocrinology;Division of Clinical Epidemiology;Department of Anesthesiology;Department of Nursing,Jiangsu Province Official Hospital,Nanjing 210024,China;Zhongda Hospital Southeast University,Nanjing 210009,China;School of Nursing,Suzhou University,Suzhou 215006,China)

机构地区：[1]南京医科大学护理学院,江苏省南京市211166 [2]江苏省省级机关医院内分泌科,江苏省南京市210024 [3]江苏省省级机关医院临床流行病学研究室,江苏省南京市210024 [4]江苏省省级机关医院麻醉科,江苏省南京市210024 [5]江苏省省级机关医院护理部,江苏省南京市210024 [6]东南大学附属中大医院内分泌科,江苏省南京市210009 [7]东南大学附属中大医院骨科,江苏省南京市210009 [8]苏州大学护理学院,江苏省苏州市215006

出　　处：《实用老年医学》2022年第5期445-448,共4页Practical Geriatrics

基　　金：江苏省干部保健科研项目(BJ20025,BJ19027)。

摘　　要：目的调查骨科围术期老年糖尿病病人血糖管理现状,研究血糖控制水平与骨科手术预后的相关性。方法收集109例行骨科手术的老年2型糖尿病病人术前2 d至术后3 d的每天5个时点血糖水平,分析术前血糖及血糖变异水平对术后并发症的影响。结果109例病人HbA1c中位数为7.3%,24例(22.02%)病人HbA1c>8.5%,术前所有末梢血糖中位数为9.02 mmol/L,术前末梢血糖波动系数(CV)为0.28±0.10。14例病人(12.84%)术后出现并发症,其中手术部位感染10例(9.17%)。术前平均血糖>9.02 mmol/L组相较于术前平均血糖≤9.02 mmol/L组,术后并发症发生率更高(20.37%比5.45%,P<0.05),手术部位感染率显著增加(14.81%比3.64%,P<0.05)。术前血糖CV>0.29组相较于血糖CV≤0.29组,围术期低血糖事件发生率显著增加(29.63%比9.09%,P<0.05)。结论合并糖尿病的老年骨科手术病人围术期血糖管理现状有待改善。加强术前血糖监测与管理,有利于降低老年糖尿病病人骨科手术并发症发生率。Objective To investigate the status of perioperative blood glucose management in the elderly patients with diabetes,and to study the correlation between blood glucose control level and prognosis of orthopedic surgery.Methods The level of blood glucose was collected at 5 time-points per day from 2 days before surgery to 3 days after surgery in the elderly patients with type 2 diabetes who underwent orthopedic surgery.The effects of blood glucose levels and blood glucose variations on postoperative complications were analyzed.Results The median HbA1c of 109 patients was 7.3%,and 24 patients(22.02%)presented with HbA1c>8.5%.The median preoperative peripheral blood glucose was 9.02 mmol/L,and the preoperative peripheral blood glucose coefficient of variation(CV)was 0.28±0.10.There were 14 patients(12.84%)with postoperative complications,including 10 patients(9.17%)with surgical site infection.The incidence of postoperative complications and surgical site infection in the group with a level of preoperative blood glucose>9.02 mmol/L was significantly higher than that in the group with a level of preoperative blood glucose≤9.02 mmol/L(20.37%vs 5.45%;14.81%vs 3.64%,respectively,all P<0.05).The incidence of perioperative hypoglycemic events in the group with preoperative CV>0.29 was significantly higher than that in the group with preoperative CV≤0.29(29.63%vs 9.09%,P<0.05).Conclusions The status of perioperative blood glucose management in the elderly patients with diabetes undergoing orthopedic surgery needs to be improved.Strengthening preoperative blood glucose monitoring and management is beneficial to reduce the incidence of orthopedic surgery complications in the elderly diabetic patients.

关 键 词：老年人 糖尿病 血糖管理 骨科手术 预后 

分 类 号：R587.1[医药卫生—内分泌] R687.3[医药卫生—内科学]