摘要
目的:分析2型糖尿病患者围手术期血糖变异性与经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)术后手术部位感染(surgical site infection,SSI)的相关性。方法:回顾分析2018年1月~2021年4月305例在东南大学附属中大医院脊柱外科接受TLIF的合并2型糖尿病的腰椎退行性疾病(lumbar degenerative diseases,LDD)患者,其中男性133例,女性172例,平均年龄67.6±9.3岁。收集所有患者的病历资料,一般资料包括性别、年龄、体质指数(bodymassindex,BMI)(是否≥25kg/m^(2))、糖尿病病程、是否合并高血压、是否合并冠心病、入院空腹血糖、术前糖化血红蛋白(glycosylated hemoglobin Alc,HbAlc)、术前及术后平均空腹血糖(mean fasting blood glucose,MFBG)、术前降糖方案(①口服降糖药;②皮下注射胰岛素;联合用药:口服降糖药+皮下注射胰岛素;④饮食疗法)。手术相关资料包括术中出血量、术中输血量、手术时间、手术节段(是否≥2个)、术后引流时间、术后引流量、切口长度。血糖变异性(glycemic variability,GV)监测指标包括术前及术后的空腹血糖水平的标准差(standard deviation of blood glucose,SDBG)、空腹血糖变异系数(coefficient of variation,CV)、空腹血糖最大变异幅度(largest amplitude of glycemic excursions,LAGE)、日间血糖平均绝对差(mean of dailydiferences,MODD)。根据SSI诊断标准确定术后SSI病例,将患者分为感染组与非感染组。对比两组患者术前及术后的血糖变异性指标,即SDBG、CV、LAGE、MODD等进行分析,同时通过相关性分析和受试者工作特征曲线(receiver operating characteristic curve,ROC)探讨围手术期血糖变异性参数和患者TLIF术后SSI的关系及其预测价值。结果:305例患者中发生SSI者51例,单因素分析显示糖尿病病程、术前及术后的MFBG、SDBG、CV、LAGE、MODD、术前降糖方案、手术节段、术后引流时间、切口长度等因素两组间比较差异�
Objectives:To analyze the correlation between perioperative glycemic variability and surgical site infection(SSI)following transforaminal lumbar interbody fusion(TLIF)in patients with type 2 diabetes mellitus.Methods:This study retrospectively analyzed 305 patients with lumbar degenerative diseases(LDD)and type 2 diabetes who underwent TLIF in the Spinal Surgery Department of Zhongda Hospital Affliated to Southeast University from January 2018 to April 2021.There were 133 males and 172 females with an average age of 67.6+9.3 years.The medical records of all patients were collected,and postoperative infection cases were determined according to the diagnostic criteria of surgical site infection.General information included gender,age,whether combined with body mass index(BMI)≥25kg/m^(2),duration of diabetes mellitus,whether combined with hypertension,whether combined with coronary heart disease,fasting blood glucose on admission,preoperative glycosylated hemoglobin Alc(HbAlc),preoperative and postoperative mean fasting blood glucose(MFBG),and preoperative hypoglycemic scheme(oral hypoglycemic drugs;②subcutaneous insulin injection;③combined medication:oral hypoglycemic drugs+subcutaneous insulin injection;④diet therapy).Surgery-related data included intraoperative blood loss,intraoperative blood transfusion,duration of operation,the number of operative levels≥(2 or not),postoperative drainage time,postoperative drainage volume,and length of the incision.Glycemic variability monitoring indicators included standard deviation of blood glucose(SDBG),coefficient of variation(CV),largest amplitude of glycemic excursions(LAGE),and mean of daily dfferences(MODD).Patients were divided into the infection group and non-infection.Preoperative and postoperative glycemic variability indexes of the above 2 groups were compared,including SDBG,CV,LAGE,and MODD.The correlation analysis and receiver operating characteristic(ROC)curve were used to investigate the relationship between perioperative glycemic variability and pos
作者
刘杭
张微
刘磊
谢志阳
徐玉柱
樊攀
王运涛
LIU Hang;ZHANG Wei;LIU Lei(Department of Orthopedics,the 904th Hospital of PLA Joint Logistic Support Force,Wuxi,214044,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2022年第9期779-787,共9页
Chinese Journal of Spine and Spinal Cord
关键词
2型糖尿病
血糖变异性
经椎间孔腰椎椎间融合术
手术部位感染
Type 2 diabetes mellitus
Glycemic variability
Transforaminal lumbar interbody fusion
Surgical siteinfection
