围术期停用二甲双胍对糖尿病患者血糖及认知功能影响
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摘要
目的探讨围术期停用二甲双胍,改为短效胰岛素控制血糖,对行单侧全髋关节置换术的老龄糖尿病患者术后认知功能及血糖波动的影响。方法选取自2016年1月至2017年1月大连医科大学附属二院收治的79例择期行单侧全髋关节置换术的老龄糖尿病患者为研究对象。将所有患者分为3组,平素应用二甲双胍,围术期继续应用者纳入A组(n=24),平素应用降糖方式中无二甲双胍者纳入B组(n=28),平素应用二甲双胍术前1 d改为短效胰岛素者纳入C组(n=27)。分别应用简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)对患者的认知功能进行评估。结果与术前相比较,3组拔管后5 min MMSE评分均有明显降低,且A组、B组MMSE评分均高于C组,差异有统计学意义(P <0. 05)。术后第1、3、7天,3组MMSE评分较术前均无明显降低,3组间比较,差异均无统计学意义(P> 0. 05)。与术前比较,3组患者拔管后5 min、术后第1、3天MoCA评分均明显降低(P <0. 05)。术后同一时间点MoCA评分比较,A组、B组均高于C组,组间比较,差异有统计学意义(P <0. 05)。3组患者围术期血糖值均有波动,在术中、拔管后5 min、术后1、3、7 d,C组的血糖值均高于A组和B组,差异有统计学意义(P <0. 05)。3组患者术前与术后肾功能(尿素氮、肌酐值)均未见明显改变,组间比较,差异无统计学意义(P> 0. 05)。静止及活动时3组患者VAS评分比较,差异均无统计学意义(P>0. 05)。3组患者恶心呕吐等不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论二甲双胍对术后认知功能的改变未产生明显影响。围术期改为短效胰岛素不利于稳定患者血糖,对短期轻度认知功能会产生不利的影响。
Objective To investigate the effect of perioperative discontinuation of metformin and the control of blood glucose by shortacting insulin on postoperative cognitive function and blood glucose fluctuation in elderly diabetic patients undergoing unilateral total hip arthroplasty( THA). Methods A retrospective study was performed on 79 cases of elderly patients who underwent THA from January 2016 to January 2017. All patients were divided into 3 groups,Group A( n = 24),patients took metformin in daily time,continued metformin during perioperative period;Group B( n = 28),patients usually in the application of hypoglycemic way without metformin;Group C( n = 27),patients took metformin in daily time,1 day before surgery,short-acting insulin was used. The cognitive function of patients was evaluated by the simple intelligent mental state examination scale( MMSE) and the Montreal cognitive assessment scale(MoCA). Results MMSE scores in 3 groups significantly reduced after 5 minutes of extubation than that before surgery,and MMSE scores in Group A and Group B were higher than those in Group C( P < 0. 05). At day 1,3 and 7 after surgery,MMSE scores of the3 groups showed no significant reduction compared with those before surgery,and the difference between the three groups was not statistically significant( P > 0. 05). MoCA scores were significantly reduced 5 minutes after extubation,1 and 3 days after surgery in all3 groups compared with those before surgery( P < 0. 05). MoCA scores in Group A and Group B were higher than that in Group C at the same time after surgery( P < 0. 05). Three groups of patients with perioperative blood glucose levels were fluctuated in operation,5 minutes after extubation,postoperative 1,3,7 days,blood glucose level in Croup C was higher than that in Group A and Group B(P < 0. 05). The renal function(urea nitrogen and creatinine)of the three groups did not change significantly before and after surgery,and the difference between the groups was not statistically significant( P > 0. 05). VAS scores of the three groups were compared at rest and activity and the difference was not statistically significant( P > 0. 05). The incidence of adverse reactions such as nausea and vomiting in the three groups was not statistically significant( P > 0. 05). Conclusion Metformin dose not significantly affect postoperative changes in cognitive function. The perioperative change to short-acting insulin is not conducive to the stabilization of patients' blood glucose,and will have adverse effects on short-term mild cognitive function.
Objective To investigate the effect of perioperative discontinuation of metformin and the control of blood glucose by shortacting insulin on postoperative cognitive function and blood glucose fluctuation in elderly diabetic patients undergoing unilateral total hip arthroplasty( THA). Methods A retrospective study was performed on 79 cases of elderly patients who underwent THA from January 2016 to January 2017. All patients were divided into 3 groups,Group A( n = 24),patients took metformin in daily time,continued metformin during perioperative period;Group B( n = 28),patients usually in the application of hypoglycemic way without metformin;Group C( n = 27),patients took metformin in daily time,1 day before surgery,short-acting insulin was used. The cognitive function of patients was evaluated by the simple intelligent mental state examination scale( MMSE) and the Montreal cognitive assessment scale(MoCA). Results MMSE scores in 3 groups significantly reduced after 5 minutes of extubation than that before surgery,and MMSE scores in Group A and Group B were higher than those in Group C( P < 0. 05). At day 1,3 and 7 after surgery,MMSE scores of the3 groups showed no significant reduction compared with those before surgery,and the difference between the three groups was not statistically significant( P > 0. 05). MoCA scores were significantly reduced 5 minutes after extubation,1 and 3 days after surgery in all3 groups compared with those before surgery( P < 0. 05). MoCA scores in Group A and Group B were higher than that in Group C at the same time after surgery( P < 0. 05). Three groups of patients with perioperative blood glucose levels were fluctuated in operation,5 minutes after extubation,postoperative 1,3,7 days,blood glucose level in Croup C was higher than that in Group A and Group B(P < 0. 05). The renal function(urea nitrogen and creatinine)of the three groups did not change significantly before and after surgery,and the difference between the groups was not statistically significant( P > 0. 05). VAS scores of the three groups were compared at rest and activity and the difference was not statistically significant( P > 0. 05). The incidence of adverse reactions such as nausea and vomiting in the three groups was not statistically significant( P > 0. 05). Conclusion Metformin dose not significantly affect postoperative changes in cognitive function. The perioperative change to short-acting insulin is not conducive to the stabilization of patients' blood glucose,and will have adverse effects on short-term mild cognitive function.
引文
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[10] Fransgaard T,Thygesen LC,Gogenur I. Metformin increases overall survival in patients with diabetes undergoing surgery for colorectal cancer[J]. Ann Surg Oncol,2016,23(5):1569-1575.
[11] Tian RH,Zhang YG,Wu Z,et al. Effects of metformin on survival outcomes of lung cancer patients with type 2 diabetes mellitus:a meta-analysis[J]. Clin Transl Oncol,2016,18(6):641-649.
[12] Sarkaki A,Farbood Y,Badavi M,et al. Metformin improves anxiety-like behaviors through AMPK-dependent regulation of autophagy following transient forebrain ischemia[J]. Metab Brain Dis,2015,30(5):1139-1150.
[13] Becquemont L,Bauduceau B,Benattar-Zibi L,et al. Cardiovascular Drugs and Metformin Drug Dosage According to Renal Function in Non-Institutionalized Elderly Patients[J]. Basic Clin Pharmacol Toxicol,2016,118(6):468-473.
[14] Xia C,Zhu L,Shao W,et al. The effect of hippocampal cognitive impairment and XIAP on glucose and lipids metabolism in rats[J]. Cell Physiol Biochem,2016,38(2):609-618.
[2]中华医学会麻醉学分会.围术期血糖管理专家共识(快捷版)[J].临床麻醉学杂志,2016,32(1):93-95.
[3]高明月,杨珉,况伟宏,等.简易精神状态量表得分的影响因素和正常值的筛查效度评价[J].北京大学学报(医学版),2015,3:443-449.
[4] Lebedeva E,Huang M,Koski L. Comparison of alternate and original items on the montreal cognitive assessment[J]. Can Geriatr J,2016,19(1):15-18.
[5]高万露,汪小海.患者疼痛评分法的术前选择及术后疼痛评估的效果分析[J].实用医学杂志,2013,29(23):3892-3894.
[6]谭今,黄克力,于涛,等.不同循环模式对冠状动脉旁路移植术后认知功能的远期影响[J].临床军医杂志,2016,1:30-33.
[7]张玫,马中原,周愚,等.不同麻醉及术后镇痛方式对老年股骨骨折患者术后早期认知功能的影响[J].临床误诊误治,2016,29(10):97-100.
[8] Alves RL,Cerqueira MP,Kraychete NC,et al. Perioperative blood glucose level and postoperative complications in pediatric cardiac surgery[J]. Arq Bras Cardiol,2011,97(5):372-379.
[9]陈彬,张星光,程千鹏,等.艾塞那肽联合二甲双胍对初诊成人2型糖尿病患者血糖控制效果观察[J].解放军医药杂志,2016,28(5):66-69.
[10] Fransgaard T,Thygesen LC,Gogenur I. Metformin increases overall survival in patients with diabetes undergoing surgery for colorectal cancer[J]. Ann Surg Oncol,2016,23(5):1569-1575.
[11] Tian RH,Zhang YG,Wu Z,et al. Effects of metformin on survival outcomes of lung cancer patients with type 2 diabetes mellitus:a meta-analysis[J]. Clin Transl Oncol,2016,18(6):641-649.
[12] Sarkaki A,Farbood Y,Badavi M,et al. Metformin improves anxiety-like behaviors through AMPK-dependent regulation of autophagy following transient forebrain ischemia[J]. Metab Brain Dis,2015,30(5):1139-1150.
[13] Becquemont L,Bauduceau B,Benattar-Zibi L,et al. Cardiovascular Drugs and Metformin Drug Dosage According to Renal Function in Non-Institutionalized Elderly Patients[J]. Basic Clin Pharmacol Toxicol,2016,118(6):468-473.
[14] Xia C,Zhu L,Shao W,et al. The effect of hippocampal cognitive impairment and XIAP on glucose and lipids metabolism in rats[J]. Cell Physiol Biochem,2016,38(2):609-618.