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| 术中血糖变异度与不良预后相关性的研究进展 |
| Research progress on correlation between increased intraoperative glucose variability and poor prognosis |
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| DOI：10.12089/jca.2022.09.016 |
| 中文关键词: 血糖变异度 连续血糖监测 预后 |
| 英文关键词: Glycemic variability Continuous glucose monitor Prognosis |
| 基金项目:北京清华长庚医院青年启动基金（12021C1005） |
| 作者 | 单位 | E-mail | | 段怡 | 102218,清华大学附属北京清华长庚医院麻醉科,清华大学临床医学院 | | | 崔蕾 | 102218,清华大学附属北京清华长庚医院麻醉科,清华大学临床医学院 | | | 陈晔 | 102218,清华大学附属北京清华长庚医院麻醉科,清华大学临床医学院 | | | 高志峰 | 102218,清华大学附属北京清华长庚医院麻醉科,清华大学临床医学院 | sunshine_duan@163.com | | 张欢 | 102218,清华大学附属北京清华长庚医院麻醉科,清华大学临床医学院 | |
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| 中文摘要: |
| 血糖变异度（GV）作为衡量血糖控制质量的新指标，与高血糖、低血糖共同组成了血糖管理的三大要素。近年来研究表明，GV可预测糖尿病相关不良反应。根据观察时限不同，GV可分为长期GV与短期GV，术中GV属于短期GV。基础研究表明，剧烈的血糖波动可通过加剧氧化应激和炎症反应介导不良事件发生，但在临床尚未获得一致性结果。临床实践中连续葡萄糖监测可实现术中GV评估，但缺乏相应的血糖调整方案控制术中GV。术中GV增高可能与手术部位感染（SSIs）、认知功能障碍、心血管不良事件和院内死亡率等不良事件发生率上升有关。本文拟对术中GV的监测方法和术中GV与不良预后的相关性、可能机制进行综述，为探索术中GV在围术期血糖管理中的临床价值、改善糖尿病患者手术预后提供参考。 |
| 英文摘要: |
| Glycemic variability (GV), an emerging determinant parameter of achieving optimal glycemic control, together with hyperglycemia and hypoglycemia, constitute the three major elements of glycemic management. Recent studies have shown that GV can predict the occurrence of diabetes-related adverse reactions. GV can be divided into long-term GV and short-term GV according to the duration of observation. Intraoperative GV is a short-term GV. Emerging evidence suggests that intense blood glucose fluctuations may contribute to adverse events by exacerbating oxidative stress and inflammatory responses, but consistent results have not been obtained in the clinical setting. Continuous glucose monitor helps to achieve intraoperative GV assessment, but there is a lack of appropriate glucose adjustment protocols to control GV. Several retrospective studies have suggested that it may be associated with increased incidence of adverse events, such as, surgical site infections (SSIs), delirium, severe cardiovascular complications, and namely postoperative mortality. This review encapsulates the correlation between methods to achieve intraoperative GV monitoring and elevated intraoperative GV and poor prognosis of patients, possible underlying mechanisms, in order to explore the clinical value of intraoperative GV in perioperative glucose management and improve the prognosis of diabetic patients. |
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