肝移植手术围术期高血糖或血糖波动与术后急性肾损伤的关系.PDFVIP

肝移植手术围术期高血糖或血糖波动与术后急性肾损伤的关系 ：一项回顾性观 察研究 Association Between Perioperative Hyperglycemia or Glucose Variability and Postoperative Acute Kidney Injury After Liver Transplantation: A Retrospective Observational Study Yoo, Seokha MD; Lee, Ho-Jin MD; Lee, Hannah MD, PhD; Ryu, Ho-Geol MD, PhD Anesthesia Analgesia: 2017 124 35–41 背景 ：肝移植术中和术后早期的血糖调控较为困难。在重症患者中高血糖和血 糖波动可能与急性肾损伤（AKI ）的发生有关。通过此项回顾性研究来验证以 下假设：围术期血糖水平（以时间加权的平均血糖水平和血糖波动值代表）是 肝移植患者术后AKI 发生的独立相关因素。 方法 ：以肝移植术中和术后48h 内的血糖水平为基准，根据时间加权的血糖平 均水平将成人肝移植受体分成4 组：正常血糖组（80-200 mg/dL ）、轻度高血糖 组（200-250 mg/dL ）、中度高血糖组（250-300 mg/dL ）和重度高血糖组（300 mg/dL ）。同时根据以血糖测值的标准差定义的血糖波动情况将患者分入4 个分 位数。主要预后指标为术后AKI 的发生。 结果 ：肝移植术后AKI 的发生更常见于围术期血糖波动较大的患者（与第1 四 分位数相比，第 3 四分位数的比值比为 2.47, [95%置信区间，1.22-5] ，P=0.012 ； 与第1 四分位数相比，第4 四分位数的比值比为2.16 ，[95%置信区间，1.05- 4.42] ，P = 0.035 ）。 结论 ：此研究提示围术期血糖波动增加而非高血糖是肝移植受体术后AKI 发生 的独立危险因素。 （戴依利 译 陈杰 校） BACKGROUND: Glucose control can be difficult in the intraoperative and immediate postoperative period of liver transplantation. Hyperglycemia and glucose variability have been associated with acute kidney injury (AKI) in critically ill patients. We performed a retrospective study to test the hypothesis that perioperative glucose levels represented by time-weighted average glucose levels andglucose variability are independently associated with the incidence of postoperative AKI in patients undergoing liver transplantation. METHODS: On the basis of blood glucose levels during liver transplantation and the initial 48 hours postoperatively, adult livertransplant recipients were classified into 4 groups according to their time-weighted average glucose: normoglycemia (80-200 mg/dL), mild hyperglycemia (200-250 mg/dL), moderate hyperglycemia (250-300 mg/dL), and severe hyperglycemia (300 mg/dL) group. Patients were also classified into quartiles depending on their glucose variability, defined as the standard deviation of glucosemeasurements. The primary outcome was postoperativ