增生性糖尿病视网膜病变患者围手术期血糖特点及影响因素分析
증생성당뇨병시망막병변환자위수술기혈당특점급영향인소분석
Influential factors of blood glucose during perioperative period for patients with proliferative diabetic retinopathy
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2014年 3期 262-265 ,共4页

    李岩%刘佳%齐朋承%王凯

    리암%류가%제붕승%왕개

    糖尿病视网膜病变%血糖%围手术期 糖尿病視網膜病變%血糖%圍手術期
    당뇨병시망막병변%혈당%위수술기
    Proliferative diabeticretinopathy%Blood glucose%Perioperative period
    背景 增生性糖尿病视网膜病变(PDR)的主要治疗方法之一是行玻璃体切割手术,以挽救患眼残存的视功能,围手术期的血糖水平控制对于手术的成功率影响较大.了解PDR患者围手术期的血糖波动特点和影响因素有助于改善PDR术眼的预后. 目的 研究PDR患者围手术期血糖特点及其影响因素.方法 采用回顾性系列病例观察研究设计.纳入2013年3-8月于北京大学人民医院行玻璃体切割手术的PDR患者100例100眼,包括1型糖尿病患者8例,2型糖尿病患者92例.参照第一次全国眼底病会议制定的分期标准,将PDR分为Ⅳ、Ⅴ、Ⅵ期.收集患者围手术期身高、体质量、高血压病史、PDR分期、既往胰岛素使用情况、糖化血红蛋白(HbA1c)水平、血压、围手术期血糖、手术前后及不同术后体位的血糖水平等临床资料进行分析,采用汉密尔顿焦虑量表对患者手术前后的焦虑程度进行评分.结果 多元线性回归分析表明,围手术期使用胰岛素的PDR患者,术前0.5h血糖值相对较低(r=-1.64,P＜0.05)；HbA1c对患者围手术期各时间点的血糖水平均有影响(P＜0.05)；手术当天等待的时间越长,术后第1天晨起空腹血糖越高(r=0.54,P＜0.05)；手术持续时间越长,术后即刻血糖和术后第1天晨起空腹血糖越高(r=0.62、0.51,P＜0.05)；而术后体位主要影响术后即刻的血糖水平(r=1.10,P＜0.05),视网膜玻璃体切割术后需要俯卧位的患者,其术后即刻血糖水平偏高；入院焦虑程度分别会影响入院时和术后第1天早、中、晚餐后2h血糖水平(r=0.13、0.07、0.05、0.10,均P＜0.05),术前焦虑及术后即刻焦虑则导致相应时间点血糖的增加(r=0.14、0.16,均P＜0.05).患者的焦虑程度与血糖波动存在明显的正相关(ρ=0.47,P＜0.01).HbA1c正常者围手术期各时间点的血糖值均明显低于HbA1c升高者,差异均有统计学意义(P＜0.05). 结论 PDR患者保持较低的HbA1c水平,良好的医患沟通,适时辅以镇静药物,减少患者术前等待时间和手术时间,可改善PDR患者围手术期的血糖水平,有利于手术的进行和术后恢复.
    배경 증생성당뇨병시망막병변(PDR)적주요치료방법지일시행파리체절할수술,이만구환안잔존적시공능,위수술기적혈당수평공제대우수술적성공솔영향교대.료해PDR환자위수술기적혈당파동특점화영향인소유조우개선PDR술안적예후. 목적 연구PDR환자위수술기혈당특점급기영향인소.방법 채용회고성계렬병례관찰연구설계.납입2013년3-8월우북경대학인민의원행파리체절할수술적PDR환자100례100안,포괄1형당뇨병환자8례,2형당뇨병환자92례.삼조제일차전국안저병회의제정적분기표준,장PDR분위Ⅳ、Ⅴ、Ⅵ기.수집환자위수술기신고、체질량、고혈압병사、PDR분기、기왕이도소사용정황、당화혈홍단백(HbA1c)수평、혈압、위수술기혈당、수술전후급불동술후체위적혈당수평등림상자료진행분석,채용한밀이돈초필량표대환자수술전후적초필정도진행평분.결과 다원선성회귀분석표명,위수술기사용이도소적PDR환자,술전0.5h혈당치상대교저(r=-1.64,P＜0.05)；HbA1c대환자위수술기각시간점적혈당수평균유영향(P＜0.05)；수술당천등대적시간월장,술후제1천신기공복혈당월고(r=0.54,P＜0.05)；수술지속시간월장,술후즉각혈당화술후제1천신기공복혈당월고(r=0.62、0.51,P＜0.05)；이술후체위주요영향술후즉각적혈당수평(r=1.10,P＜0.05),시망막파리체절할술후수요부와위적환자,기술후즉각혈당수평편고；입원초필정도분별회영향입원시화술후제1천조、중、만찬후2h혈당수평(r=0.13、0.07、0.05、0.10,균P＜0.05),술전초필급술후즉각초필칙도치상응시간점혈당적증가(r=0.14、0.16,균P＜0.05).환자적초필정도여혈당파동존재명현적정상관(ρ=0.47,P＜0.01).HbA1c정상자위수술기각시간점적혈당치균명현저우HbA1c승고자,차이균유통계학의의(P＜0.05). 결론 PDR환자보지교저적HbA1c수평,량호적의환구통,괄시보이진정약물,감소환자술전등대시간화수술시간,가개선PDR환자위수술기적혈당수평,유리우수술적진행화술후회복.
    Background Proliferative diabetic retinopathy (PDR) is a serious complication of diabetes mellitus,and vitrectomy is a main treatment.Exploring the influential factors of blood glucose fluctuation during perioperative duration is helpful for surgery.Objective The aim of this study was to explore glycolic fluctuation and its influential factors in PDR patients.Methods A retrospective cases-observational study was carried out.The clinical data of 100 PDR patients who received vitrectomy in Peking University People's Hospital from March to August in 2013 were collected,including 8 cases with type 1 diabetes mellitus and 92 cases with type 2 diabetes mellitus.The PDR patients were staged as Ⅳ,Ⅴ,Ⅵ based on the criteria of The First National Fudus Conference.The body height,weight,history of hypertension,PDR stage,previous usage of insulin,glycosylated hemoglobin (HbA1c) level,admission blood pressure,blood glucose level in different time points and postoperative body positions were recorded,and perioperative anxiety was scored according to the Hamilton Anxiety Scale (HAMA).Repeated ANOVA was used to analyze blood glucose and anxiety at different time points.Results The linear regression analysis showed that the preoperative blood glucose level was lower in the patients who used insulin during perioperative period(r =-1.64,P＜0.05).HbA1 c level showed the positive correlations with the blood glucose level at different time points(all at P＜0.05).The waiting time for surgery had a positive correlation with the fasting blood glucose in the morning of operative day(r=0.54,P＜0.05),and the postoperative position primarily caused the raise of postoperative right blood glucose(r =1.10,P＜0.05).The anxiety score on admission presented with the positive correlations with the blood glucose levels at admission and 2 hours after breakfast,lunch and dinner on the first postoperative day (r=0.13,0.07,0.05,0.10,all at P ＜ 0.05),and the high anxiety scores at preoperation and postoperation induced the high blood glucose levels at the corresponding time points (r =0.14,0.16,both at P＜0.05).A positive correlation was found between the anxiety score and blood glucose fluctuation values (ρ=0.47,P＜0.01).The blood glucose values were significantly lower in the patients with normal HbA1c than those with high HbA1c (all at P ＜ 0.05).Conclusions Remaining an ideal HbA1c level,establishing a good doctor-patient relationship and administering appropriate sedative drugs can ease the anxiety and improve the glycolic of PDR patients during preoperative duration.
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