冠心病合并2型糖尿病患者经皮冠状动脉介入治疗围术期血糖波动的特点及影响因素研究  

Characteristics and Influencing Factors of Glycemic Fluctuation in Patients with Coronary Heart Disease with Type 2 Diabetes during the Peri-PCI Period

作　　者：徐迪 田金萍 刘赟玥 薛冷 张林 孙国珍 王连生 徐晶晶 XU Di;TIAN Jinping;LIU Yunyue;XUE Leng;ZHANG Lin;SUN Guozhen;WANG Liansheng;XU Jingjing(School of Nursing,Nanjing Medical University,Nanjing 211166,China;The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital,Nanjing 210029,China)

机构地区：[1]南京医科大学护理学院,江苏省南京市211166 [2]南京医科大学第一附属医院,江苏省人民医院,江苏省南京市210029

出　　处：《中国全科医学》2023年第15期1863-1872,共10页Chinese General Practice

基　　金：江苏省高校优势学科建设工程项目(苏政办发[2018]87号);江苏省人民医院“临床能力提升工程”项目(JSPH-NA-2020-2)。

摘　　要：背景 冠心病患者经皮冠状动脉介入治疗(PCI)围术期的血糖波动与其近、远期预后密切相关。目前,关于患者PCI围术期血糖变化规律及其影响因素的研究较少。目的 探究冠心病合并2型糖尿病患者PCI围术期血糖波动的特点及影响因素。方法 选取2021年4—11月在江苏省人民医院心内科病房进行PCI的156例患者为研究对象,分别按照血糖波动评价指标的参考值对患者进行分组:按照血糖水平标准差(SDBG)将患者分为SDBG正常组(<2.0mmol/L,n=58)和SDBG高波动组(≥2.0 mmol/L,n=98);按照餐后血糖波动幅度(PPGE)将患者分为PPGE正常组(<2.2 mmol/L,n=28)和PPGE高波动组(≥2.2 mmol/L,n=128);按照最大血糖波动幅度(LAGE)将患者分为LAGE正常组(<4.4 mmol/L,n=39)和LAGE高波动组(≥4.4 mmol/L,n=117)。采用一般资料调查表、血糖相关资料调查表收集患者一般资料和围术期血糖波动情况;分别采用匹兹堡睡眠质量指数量表(PSQI)、医院焦虑抑郁自评量表(HAD)、数字疼痛强度评估量表(NRs)评估患者睡眠质量、焦虑抑郁情况及围术期疼痛状况。采用Pearson相关分析和Spearman秩相关分析探讨患者PCI围术期与血糖波动相关的因素,采用多元线性回归分析探讨患者PCI围术期血糖波动的影响因素。结果 SDBG正常组和SDBG高波动组患者糖尿病病程、控糖方案、糖化血红蛋白(HbA_(1c))、围术期饮食量变化、手术开始时间段、手术持续时长、支架/球囊植入情况、NRs评分比较,差异有统计学意义(P<0.05),SDBG正常组HbA_(1c)低于SDBG高波动组;PPGE正常组和PPGE高波动组患者控糖方案、体质指数(BMI)、总胆固醇(TC)、围术期饮食量变化比较,差异有统计学意义(P<0.05),PPGE正常组BMI、TC高于PPGE高波动组;LAGE正常组和LAGE高波动组患者糖尿病病程、控糖方案、TC、HbA_(1c)、NRs评分比较,差异有统计学意义(P<0.05),LAGE正常组TC高于LAGE高波动组,HbA_(1c)低于LAGE高波Background The glycemic fluctuation in peri-percutaneous coronary intervention(PCI)period is closely related to the short-term and long-term prognosis in patients with coronary heart disease(CHD). At present,there are few studies on glycemic fluctuation and its influencing factors in peri-PCI period in these patients. Objective To explore the characteristics and influencing factors of glycemic fluctuation during peri-PCI period in patients with CHD and type 2 diabetes(T2DM). Methods One hundred and fifty-six patients undergoing PCI in the cardiology ward of Jiangsu Provincial People’s Hospital from April 2021 to November 2021 were selected. General demographics were collected by general demographics questionnaire. Perioperative glycemic fluctuation was collected by glycemic data questionnaire. The patients were stratified according to the normal reference value range of blood glucose fluctuation evaluation indicators:normal standard deviation of blood glucose level(SDBG) group(<2.0 mmol/L,n=58)and high SDBG group (≥ 2.0 mmol/L,n=98) by the SDBG level;normal amplitude of postprandial glycemic excursions(PPGE) group(<2.2 mmol/L,n=28) and high PPGE group (≥ 2.2mmol/L,n=128) by the PPGE;normal largest amplitude of glycemic excursion(LAGE) group(<4.4 mmol/L,n=39)and high LAGE group (≥ 4.4 mmol/L,n=117) by the LAGE. The Pittsburgh Sleep Quality Index(PSQI)was used to assess sleep quality. The Hospital Anxiety and Depression Scale(HAD)was used to identify depression and anxiety. The Numeric Rating Scale(NRs)used to assess pain intensity in peri-PCI period. Pearson and Spearman correlation analyses were used to study the correlation of factors related to blood glucose fluctuation during the peri-PCI period. Multiple linear regression analysis was used to explore the factors associated with blood glucose fluctuation during the peri-PCI period. Results Normal and high SDBG groups had statistically significant differences in course of diabetes,use of glucose control regimen,mean values of HbA_(1c),changes in dieatar

关 键 词：冠心病 糖尿病 2型 经皮冠状动脉介入治疗 血糖波动 影响因素分析 回归分析 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]