围手术期高血糖症增加术后感染风险

桃子妖妖 · 发表于 2009-8-26 18:10:37

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国布里格姆(Brigham)和女性医院的拉莫斯(Ramos)等近日报告,对接受普通外科手术和血管手术的患者,围手术期高血糖与术后感染(POI)风险升高有关,且该相关性与糖尿病状态无关。相关论文发表于《外科学年鉴》[AnnSurg2008,248(4):585].
该回顾性研究共纳入了995例接受了普通外科和血管外科手术的患者。研究者分析了所有患者围手术期急性高血糖症与在术后18个月内发生30天POI风险的关系.
结果发现,在双因素分析中,术前血糖(P=0.012)、术后血糖(POG)水平(P=0.009)、年龄(P=0.002)、糖尿病(P=0.04)、美国麻醉学会分级(ASAC)(P<0.0001)、手术时间长度(P=0.02)和输血(P=0.02)都是POI的显著预测因素。在多因素分析中,只有POG水平(OR=1.3)、ASAC(OR=1.9)和紧急状态(OR=2.2)仍然是POI的显著预测因素。与正常血糖水平(<110mg/dl)相比,术后血糖水平每升高40mg/dl,将导致POI风险升高30%。POG水平为110mg/dl到200mg/dl(OR=1.4)之间以及POG水平>200mg/dl(OR=1.8)的患者,住院时间延长.
研究者认为,在接受普通外科手术的患者中,术后高血糖症造成的POI风险升高和住院时间延长,独立于糖尿病状态。人们需要进一步研究,来评估术后血糖控制的可能益处.

桂花香 · 发表于 2009-8-26 22:30:05

SSI预防的bundle里面就有控制血糖水平这一建议，患者血糖高与SSI的发生有关。

桃子妖妖 · 发表于 2009-8-26 22:53:20

quote]在SSI预防的bundle里面就有控制血糖水平这一建议，患者血糖高与SSI的发生有关。
是的，发此贴的目的就是因为在做SSI 的目标性监测时，当要采取控制围术期血糖水平措施时，给同仁一个说服临床医生的证据（临床医生有时会问你这样做得证据呢？有文献报道吗？呵呵）。这也是当初我寻找此篇文献的目的吧。

桂花香 · 发表于 2009-8-27 06:57:43

们的临床医师已经在实际工作中实施控制血糖的措施了。

缭绕 · 发表于 2009-8-27 08:51:36

美国布里格姆(Brigham)和女性医院的拉莫斯(Ramos)等近日报告,对接受普通外科手术和血管手术的患者,围手术期高血糖与术后感染(POI)风险升高有关,且该相关性与糖尿病状态无关。相关论文发表于《外科学年鉴》[AnnSurg20 ...
桃子妖妖发表于 2009-8-26 18:10

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今年年会上听朝阳医院的曹彬主任讲SSI时，他引用了一篇类似文献，呵呵，居然是GOOGLE上搜索下来的文章广告，害得我引用时被杂志疑问？还好是D版帮我找到了原文，总算发表了啊！我的监测结果表明，控制糖尿病人的术前血糖水平后，术后的感染率可以降低！

David · 发表于 2009-8-28 11:45:51

文在此
Ann Surg. 2008 Oct;248(4):585-91. Links
Relationship of perioperative hyperglycemia and postoperative infections in patients who undergo general and vascular surgery.
Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, Rogers SO.
Brigham and Women's Hospital and Brigham and Women's Hospital Center for Surgery and Public Health, Boston, MA 02115, USA.
OBJECTIVE: Evaluate the association of perioperative hyperglycemia and postoperative infections (POI) in patients who had undergone general surgery. BACKGROUND: Intensive glucose control leads to less postoperative infections (POI) in critically ill surgical patients, but the relationship of hyperglycemia and POI in a general surgical population remains unknown.
METHODS: A retrospective study of 995 patients who had undergone general and vascular surgery investigated the association of perioperative acute hyperglycemia and risk of 30-day POI over an 18-month period. The primary predictor of interest was postoperative glucose (POG). Bivariate analyses determined the association of each independent variable with POI. Factors significant at P < 0.05 were used in multivariable logistic regression models.
RESULTS: In bivariate analyses, preoperative blood glucose (P = 0.012), POG (P = 0.009), age (P = 0.002), diabetes (P = 0.04), American Society of Anesthesia Classification (ASAC) (P < 0.0001), operation length (P = 0.02), and blood transfusions (P = 0.02) were significant predictors of POI. In multivariate analyses, only POG (OR = 1.3, (1.03-1.64)), ASAC (OR = 1.9, (1.31-2.83)), and emergency status (OR = 2.2, (1.21-3.80)) remained significant predictors of POI. Postoperative hyperglycemia increased the risk of POI by 30% with every 40-point increase from normoglycemia (<110 mg/dL). Longer hospitalization was also observed for patients with POG from 110 to 200 mg/dL (OR = 1.4, (1.1-1.7)) and >200 mg/dL (OR = 1.8, (1.4-2.5)).
CONCLUSION: The increased risk of POI and length of hospitalization posed by postoperative hyperglycemia is independent of diabetic status and needs further evaluation to assess for possible benefits of postoperative glycemic control in patients who have undergone general surgery.
PMID: 18936571 [PubMed - indexed for MEDLINE]