实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (5): 445-448.doi: 10.3969/j.issn.1003-9198.2022.05.004

• 专题论坛 • 上一篇    下一篇

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

李国庆, 巫海娣, 鞠昌萍, 孙美娟, 樊垚, 刘欢, 俞匀, 唐伟, 桂波, 莫永珍   

  1. 211166 江苏省南京市,南京医科大学护理学院(李国庆,莫永珍);
    210024 江苏省南京市,江苏省省级机关医院内分泌科(巫海娣,俞匀,唐伟);临床流行病学研究室(樊垚);麻醉科(桂波);护理部(莫永珍);
    210009 江苏省南京市,东南大学附属中大医院内分泌科(鞠昌萍);骨科(孙美娟);
    215006 江苏省苏州市,苏州大学护理学院(刘欢)
  • 收稿日期:2022-03-10 出版日期:2022-05-20 发布日期:2022-05-26
  • 通讯作者: 莫永珍,Email:moyongzh@sina.com
  • 作者简介:莫永珍 主任护师
  • 基金资助:
    江苏省干部保健科研项目(BJ20025,BJ19027)

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

LI Guo-qing, WU Hai-di, JU Chang-ping, SUN Mei-juan, FAN Yao, LIU Huan, YU Yun, TANG Wei, GUI Bo, MO Yong-zhen   

  1. LI Guo-qing, MO Yong-zhen. College of Nursing, Nanjing Medical University, Nanjing 211166, China;
    WU Hai-di, YU Yun, TANG Wei. Department of Endocrinology; FAN Yao. Division of Clinical Epidemiology; GUI Bo. Department of Anesthesiology; MO Yong-zhen. Department of Nursing, Jiangsu Province Official Hospital, Nanjing 210024, China;
    JU Chang-ping, SUN Mei-juan. Zhongda Hospital Southeast University, Nanjing 210009, China;
    LIU Huan. School of Nursing, Suzhou University, Suzhou 215006, China
  • Received:2022-03-10 Online:2022-05-20 Published:2022-05-26

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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。

关键词: 老年人, 糖尿病, 血糖管理, 骨科手术, 预后

Abstract: 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.

Key words: aged, diabetes mellitus, blood glucose management, orthopedic surgery, prognosis

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