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| 老年糖尿病患者术中血糖变异性与术后谵妄的相关性 |
| Correlation between intraoperative blood glucose variability and postoperative delirium in elderly diabetic patients |
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| DOI：10.12089/jca.2023.05.003 |
| 中文关键词: 动态血糖监测系统 血糖变异性 糖尿病 术后谵妄 |
| 英文关键词: Continuous glucose monitoring system Blood glucose variability Diabetes Postoperative delirium |
| 基金项目:国家自然科学基金（81974540） |
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| 中文摘要: |
目的 探讨基于动态血糖监测系统（CGMS）监测老年糖尿病患者的术中血糖变异性相关指标与术后谵妄（POD）的相关性。
方法 选择2020年6—10月择期行全麻手术的老年糖尿病患者126例，男61例，女65例，年龄≥65岁，BMI <28 kg/m2，ASA Ⅱ或Ⅲ级，入室后使用CGMS实时动态监测术中血糖，记录血糖变异性相关指标：变异系数（CV）、平均血糖值（GluAve）、血糖标准差（GluSD）和血糖不稳定指数（GLI）。术后1～7 d每日上午9时和下午5时采用意识模糊评估量表（CAM）评估POD发生情况，根据术后7 d内是否发生POD将患者分为两组：POD组和非POD组。采用受试者工作特征曲线(ROC)评估术中血糖变异性相关指标与发生POD的相关性。
结果 有45例（35.7%）发生POD。年龄、血糖变异性相关指标（CV、GluAve、GluSD和GLI）是老年糖尿病患者发生POD的独立危险因素（P<0.05）。CV、GluAve、GluSD和GLI的ROC曲线下面积(AUC)分别为0.651、0.789、0.664和0.700，其中GluAve对POD的预测作用最强（敏感性75.6%、特异性88.9%）。
结论 术中血糖变异性增加是老年糖尿病患者POD发生的危险因素，基于CGMS连续监测术中血糖可为早期干预血糖波动提供实时指导，以减少术后POD发生。 |
| 英文摘要: |
Objective To explore the correlation between intraoperative blood glucose variability monitored by continuous glucose monitoring system (CGMS) and postoperative delirium (POD) in elderly diabetic patients.
Methods A total of 126 elderly diabetic patients from June 2020 to October 2020 undergoing elective operation under general anesthesia, 61 males and 65 females, aged ≥ 65 years, BMI < 28 kg/m2, ASA physical status Ⅱ or Ⅲ, were selected. The CGMS was used for real-time dynamic monitoring blood glucose upon the patients entered the room. At the same time, the relevant indicators of blood glucose variability: coefficient of variation (CV), average blood glucose value (GluAve), blood glucose standard deviation (GluSD) and blood glucose instability index (GLI) were recorded. The occurrence of POD was assessed by the confusion assessment method (CAM) at 9 and 17 o'clock every day after surgery for a week. Patients were divided into two groups according to the occurrence of POD within 7 days after surgery: POD group and non-POD group. The correlation between blood glucose variability and POD was evaluated by receiver operating characteristic curve (ROC).
Results Forty-five patients (35.7%) occurred POD. Age and blood glucose variability related indicators were independent risk factors of postoperative delirium (P < 0.05). The area under the ROC curve (AUC) of CV, GluAve, GluSD, and GLI were 0.651, 0.789, 0.664, and 0.700, respectively, among which GluAve had the strongest predictive effect on POD (sensitivity was 75.6% and specificity was 88.9%).
Conclusion Excessive perioperative blood glucose fluctuations are significantly related to the incidence of POD in the elderly diabetic patients. Continuous monitoring of intraoperative blood glucose using by CGMS can provide real-time guidance for early intervention of blood glucose fluctuations to reduce the incidence of POD. |
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