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经皮冠状动脉介入治疗患者围术期血糖波动现况及影响因素分析

摘要:背景 多项研究已证明经皮冠状动脉介入治疗患者围术期血糖波动与其近、远期预后密切相关,血糖波动目前是治疗新靶点,但目前关于经皮冠状动脉介入治疗患者围术期血糖变化规律及其影响因素的研究鲜少。目的 探究冠心病合并2型糖尿病患者经皮冠状动脉介入治疗(PCI)围术期血糖波动的特点及影响因素,为临床制定精准降糖措施提供依据。方法 采用一般资料调查表、医院焦虑抑郁自评量表、匹兹堡睡眠质量指数量表、疼痛数字评分法和床旁快速血糖监测对156例冠心病合并2型型糖尿病患者进行问卷调查和血糖监测。观察经皮冠状动脉介入治疗围术期血糖波动现况,评估患者血糖水平的标准差(SDBG)、餐后血糖波动幅度(PPGE)及最大血糖波动幅度(LAGE)。结果 经皮冠状动脉介入治疗患者围术期血糖波动现况分析显示,SDBG为(2.10±0.67)mmol/L、PPGE为(2.84±1.13)mmol/L、LAGE为(5.99±2.00)mmol/L。多因素分析结果显示年龄、饮食、睡眠、手术结束至进餐时间等是PCI患者围术期SDBG的独立影响因素,解释度为19.3%;文化程度、体质指数、控糖方案、进餐至手术开始时间、手术结束至进餐时间等是PCI患者围术期PPGE的独立影响因素,解释度为21.3%;运动、糖尿病病程、疼痛、睡眠、收缩压、户籍地、手术结束至进餐时间、手术开始时间等是PCI患者围术期LAGE的独立影响因素,解释度为47.8%。结论 冠心病合并2型糖尿病患者经皮冠状动脉介入治疗围术期血糖波动的影响因素包括年龄、糖尿病病程、收缩压、户籍地、文化程度、体质指数、饮食、运动、睡眠、疼痛、手术结束至进餐时间、进餐至手术开始时间、手术开始时间段、控糖方案,临床医护人员根据这些因素为围术期患者制定个性化血糖管理方案,降低血糖波动,以改善患者预后。

英文摘要:Background A number of studies have proven that perioperative blood glucose fluctuation in patients undergoing percutaneous coronary intervention (PCI) is closely related to their short-term and long-term prognosis. New treatments targeting blood glucose fluctuation have been designed. However, the characteristics and influencing factors of this fluctuation have been rarely analyzed. Objective To explore the characteristics and influencing factors of blood glucose fluctuation during perioperative PCI in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM), and to provide a basis for formulating clinical precise anti-glycemic measures. Methods A total of 156 patients with CHD and T2DM were included. Data about blood glucose fluctuation were collected through general information questionnaire and various scales, including hospital anxiety and depression scale, Pittsburgh sleep quality index, numerical rating scale and bedside rapid blood glucose monitoring system. The standard deviation of blood glucose level (SDBG), postprandial blood glucose fluctuation range (PPGE) and maximum blood glucose fluctuation range (LAGE) were recorded. RESULTS In all the patients, SDBG was (2.10±0.67) mmol/L, PPGE was (2.84±1.13) mmol/L, and LAGE was (5.99±2.00) mmol/L. The multivariate analysis showed that age, diet, sleep, and time from the end of surgery to the first post-surgery meal were independent factors influencing SDBG during perioperative PCI, with an explanatory degree of 19.3%. Education level, BMI, anti-glycemic plan, time from the last pre-surgery meal to the initiation of surgery, and time from the end of surgery to the first post-surgery meal were independent factors influencing perioperative PPGE, with an explanation degree of 21.3%. Exercise, diabetes course, pain, sleep, systolic blood pressure, residential address, time from end of surgery to the first post-surgery meal, and time of surgery initiation were independent factors influencing perioperative LAGE, with an explanation degree of 47.8%. Conclusion The influencing factors of blood glucose fluctuation during perioperative PCI in patients with CHD and T2DM include age, diabetes course, systolic blood pressure, residential address, education level, BMI, diet, exercise, sleep, pain, time from the end of surgery to the first post-surgery meal, time from the last pre-surgery meal to the initiation of surgery, time of surgery initiation, and anti-glycemic plan. Based on these factors, personalized plans can be designed to control blood sugar fluctuations and improve patients’ prognosis

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[V1] 2022-08-12 18:31:09 chinaXiv:202208.00086V1 下载全文
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