内科理论与实践 ›› 2024, Vol. 19 ›› Issue (02): 126-129.doi: 10.16138/j.1673-6087.2024.02.07
收稿日期:
2023-05-18
出版日期:
2024-04-30
发布日期:
2024-07-08
通讯作者:
霍丽丽
E-mail:xiaohuo0327@163.com
基金资助:
BAI Yuanyuan, HUO Lili(), LI Wei, LAN Ling, DENG Wei
Received:
2023-05-18
Online:
2024-04-30
Published:
2024-07-08
Contact:
HUO Lili
E-mail:xiaohuo0327@163.com
摘要:
目的:探讨围手术期2型糖尿病(type 2 diabetes mellitus,T2DM)患者胰岛素泵治疗期间低血糖发生情况及其相关危险因素。方法:研究对象选取北京积水潭医院骨折合并T2DM围手术期行胰岛素泵强化治疗患者,共96例。收集病史,检测糖化血红蛋白(glycosylated hemoglobin, HbA1c)、肝功能、肾功能等指标,观察低血糖发生及术后并发症情况。采用Logistic回归分析探讨低血糖相关危险因素。结果:骨折合并T2DM患者术前胰岛素泵强化治疗至血糖达标时间为(2.8±1.3) d,总体低血糖发生率为15.6%。低血糖组15例,非低血糖组81例,与非低血糖组相比,低血糖组的年龄更大[(71.1±11.1)岁比(56.0±10.6)岁,P=0.000]、病程更长[14.0(8.8~17.8)年比5.0(2.8~12.0)年,P=0.017]、估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)更低[(78.7±27.5)mL/(min·1.73 m2)比(106.8±15.0)mL/(min·1.73 m2),P=0.005]、术后感染发生率更高(25%比3%,P=0.024)。多因素Logistic回归分析显示年龄大(OR=1.172,95%CI:1.027~1.091,P=0.012)、病程长(OR=1.193,95%CI:1.001~1.420,P=0.049)和eGFR低(OR=0.950,95%CI:0.903~0.998,P=0.049)是围手术期T2DM患者胰岛素泵治疗发生低血糖的危险因素。结论:围手术期T2DM患者胰岛素泵治疗可使血糖快速达标;年龄大、糖尿病病程长以及eGFR水平低是低血糖发生的危险因素。
中图分类号:
白媛媛, 霍丽丽, 李伟, 兰玲, 邓微. 围手术期2型糖尿病患者胰岛素泵治疗期间低血糖发生情况及其危险因素分析[J]. 内科理论与实践, 2024, 19(02): 126-129.
BAI Yuanyuan, HUO Lili, LI Wei, LAN Ling, DENG Wei. Occurrence and risk factors of hypoglycemia in type 2 diabetes mellitus patients treated with continuous subcutaneous insulin infusion during perioperative period[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(02): 126-129.
表1
2组患者一般资料及生化指标比较[n/( $\bar{x} \pm s$)]
项目 | 非低血糖组 (n=81) | 低血糖组 (n=15) | t/Z | P | |
---|---|---|---|---|---|
年龄(岁) | 56.0±10.6 | 71.1±11.1 | -4.484 | 0.000 | |
性别(男性/女性) | 50/31 | 5/10 | 3.448 | 0.110 | |
糖尿病病程(年) | 5(2.8~12.0) | 14.0(8.8~17.8) | -2.993 | 0.017 | |
BMI(kg/m2) | 25.1±3.5 | 25.5±4.0 | -0.233 | 0.817 | |
HbA1c(%) | 8.2±1.5 | 7.8±1.6 | 0.844 | 0.401 | |
eGFR[mL/(min·1.73 m2)] | 106.8±15.0 | 78.7±27.5 | 3.456 | 0.005 | |
是否联合口服降糖药 (是/否) | 23/58 | 5/10 | 2.139 | 0.699 | |
达标时间(d) | 2.8±1.2 | 2.7±1.4 | -0.221 | 0.826 | |
胰岛素用量[U/(Kg·d)] | 0.69±0.15 | 0.69±0.14 | -0.003 | 0.815 | |
基础量(U) | 24.3±8.4 | 22.5±7.8 | 0.676 | 0.501 | |
餐前大剂量(U) | |||||
早餐前 | 9.0±2.3 | 8.8±2.0 | 0.169 | 0.866 | |
午餐前 | 8.2±2.4 | 8.5±2.6 | -0.418 | 0.677 | |
晚餐前 | 7.8±2.2 | 7.9±2.9 | -0.195 | 0.846 |
表2
围手术期T2DM患者胰岛素泵治疗低血糖发生的多因素Logistic回归分析
变量 | β | Wald χ2 | P | OR | 95% CI |
---|---|---|---|---|---|
年龄 | 0.159 | 6.314 | 0.012 | 1.172 | 1.027~1.091 |
糖尿病病程 | 0.175 | 3.886 | 0.049 | 1.193 | 1.001~1.420 |
BMI | 0.071 | 0.242 | 0.622 | 1.074 | 0.809~1.426 |
HbA1c | 0.242 | 0.443 | 0.506 | 1.276 | 1.184~4.772 |
eGFR | -0.051 | 3.887 | 0.049 | 0.950 | 0.903~0.998 |
胰岛素用量 | -0.223 | 1.185 | 0.276 | 0.800 | 0.456~5.308 |
常量 | -9.693 | 1.964 | 0.161 | 0.000 |
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