术中严格血糖控制对肝移植术患者术后肝功能障碍的影响
Effect of strict intraoperative blood glucose control on postoperative hepatic allograft dysfunction in patients undergoing liver transplantation
崔蕾 1段怡 1高志峰 1郭娇娇 1张政 1张欢1
作者信息
- 1. 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,北京 102218
- 折叠
摘要
目的 评价术中严格血糖控制对肝移植术后肝功能障碍的影响.方法 择期原位异体肝移植术患者164例,性别不限,年龄18～64岁,BMI 18～30 kg/m2,ASA分级Ⅲ或Ⅳ级,采用随机数字表法分为术中严格血糖控制组(S组,术中控制血糖6.0～7.8 mmol/L)和常规血糖控制组(C组,术中控制血糖4.1～10.0 mmol/L).自麻醉诱导完成至术毕,每1 h测定动脉血糖,结合目标导向型血糖调控流程进行血糖管理,记录术后肝功能障碍、术后30 d内感染发生情况、脱机拔管时间、ICU停留时间和住院总时间.结果 与C组比较,S组术后肝功能障碍和术后30 d内感染发生率降低(P＜0.05),脱机拔管时间、ICU停留时间和住院总时间差异无统计学意义(P＞0.05).结论 肝移植术中严格血糖控制可降低术后肝功能障碍的发生.
Abstract
Objective To evaluate the effect of strict intraoperative blood glucose control on post-operative hepatic allograft dysfunction in patients undergoing liver transplantation.Methods A total of 164 patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of An-esthesiologists Physical Status classification Ⅲ or Ⅳ,undergoing orthotopic liver transplantation,were di-vided into strict intraoperative blood glucose control group(group S,6.0-7.8 mmol/L)and routine blood glucose control group(group C,4.1-10.0 mmol/L)using a random number table method.From the comple-tion of anesthesia induction to the end of operation,arterial blood glucose was measured every 1 h,and blood glucose management was carried out in combination with the goal-oriented blood glucose control process.The occurrence of postoperative hepatic allograft dysfunction,infection within 30 days after surgery,offline extubation time,duration of intensive care unit stay and total length of hospital stay were recorded.Results Compared with group C,the incidence of postoperative liver dysfunction and infection within 30 days after operation were significantly decreased(P＜0.05),and no significant change was found in the off-line extubation time,duration of intensive care unit stay and total length of hospital stay in group S(P＞0.05).Conclusions Strict blood glucose control during liver transplantation can decrease the development of postoperative liver dysfunction in patients.
关键词
肝移植/血糖控制/原发性移植物功能障碍Key words
Liver transplantation/Glycemic control/Primary graft dysfunction引用本文复制引用
基金项目
北京市市属医院科研培育计划(PX2021040)
北京清华长庚医院青年启动基金()
出版年
2024
NETL
NSTL
万方数据